Heterogeneity of senior medical students' knowledge on COPD pharmacotherapy: results of cluster analysis within the multicenter ASCO-IV study

Introduction . Chronic obstructive pulmonary disease (COPD) remains one of the leading causes of morbidity and mortality, requiring future physicians to have solid knowledge of diagnosis and pharmacotherapy. Objective . To assess the level of basic knowledge of senior medical students on COPD and, using cluster analysis, to identify stable competency profiles across key domains (etiology, diagnosis, pharmacotherapy, and vaccination prophylaxis). Materials and methods . As part of the fourth stage of the multicenter ASCO-IV project, an anonymous survey was conducted among 480 senior medical students from five Russian medical universities (October 2023 — May 2025). A validated original 21-item closed-ended questionnaire was used, covering etiology, diagnosis, classification, pharmacotherapy, and vaccination prophylaxis of COPD. Descriptive statistics, nonparametric tests (Kruskal-Wallis, Dunn, χ²), hierarchical cluster analysis, k-means clustering, and discriminant analysis were applied; significance was set at p < 0.05 with Bonferroni correction. Results . The median individual mean score was 65.9 % [49.4 %; 77.8 %], with significant intercenter differences (H = 102; df = 4; p < 0.0001). Four stable clusters were identified: “Students with basic knowledge” (23.5 %), “Students with fragmented knowledge” (24.2 %), “Students with a high level of knowledge” (29.6 %), and “Students with a pronounced knowledge deficit” (22.7 %). Discriminant analysis confirmed high model accuracy — 94.8 % correct classification (λ = 0.033; p < 0.001). A “clinical-pharmacological gap” was revealed: diagnostic items (1-7) were mastered at an acceptable level (mean completeness 42–92 %), whereas pharmacotherapy, especially initial maintenance therapy (items 12, 14) and antimicrobial therapy of exacerbations (items 16-19), caused persistent difficulties for most students, including the high-knowledge cluster. The association between training center and cluster type was significant (χ² = 68.25; df = 12; p < 0.001). Discussion . The identified knowledge profiles justify a transition to differentiated educational strategies: deepening complex pharmacotherapy topics for the basic-knowledge cluster, systematizing material for the fragmented-knowledge cluster, returning to the basic course for the knowledge-deficit cluster, and engaging the high-knowledge cluster in research and Olympiad activities. Study limitations include the cross-sectional design and unbalanced sample across centers. The findings are consistent with the KNOCAP-III project and indicate a systemic nature of deficits in respiratory medicine teaching.