• 1 MBBS (UM), MAFP/FRACGP, Community Based Department Universiti Kuala Lumpur, Royal College of Medicine Perak, Ipoh, Perak, Malaysia. email:
  • 2 MBBS, MAFP/FRACGP, Buntong Health Clinic, Ipoh, Perak, Malaysia
  • 3 MBBS, Simee Health Clinic, Ipoh, Perak, Malaysia
  • 4 MBBS, Ayer Tawar Health Clinic, Ayer Tawar, Perak, Malaysia
  • 5 MD, Menglembu Health Clinic, Ipoh, Perak, Malaysia
  • 6 MD, MAFP/FRACGP, Gunung Rapat Health Clinic, Ipoh, Perak, Malaysia
  • 7 MFamMed (UM), FRACGP, FAMM. Professor, Department of Family Medicine, International Medical University, Seremban Campus, Seremban, Negeri Sembilan, Malaysia
Malays Fam Physician, 2021 Mar 25;16(1):39-49.
PMID: 33948141 DOI: 10.51866/oa0002


Introduction: Atrial fibrillation (AF) is known to lead to stroke and thromboembolism, causing a five-fold increase in the risk of stroke and almost doubling the mortality rate. Optimal anticoagulant therapy is effective in reducing AF-related death. However, prescription of anticoagulants in AF in East Asian countries has been low, ranging from 0.5% to 28%. This study aimed to determine whether vocational training in family medicine improves primary care physicians' knowledge, attitude, and practice in the management of AF.

Method: This investigation was a cross-sectional study carried out during centralized workshops for two groups of trainees using a validated questionnaire: (i) junior trainees were newly enrolled postgraduate trainees in the Graduate Certificate in Family Medicine (GCFM) program, and (ii) senior trainees were postgraduate trainees in Advance Training in Family Medicine (ATFM) programs of the Academy of Family Physicians of Malaysia (AFPM).

Results: A total of 223 trainees (127 junior and 96 senior) participated in this study. Only 55.2% of the trainees passed the knowledge test; senior trainees were more likely to pass the knowledge test compared to junior trainees (69.8% vs. 44.1%, p < 0.001). Female trainees were significantly more likely to pass the knowledge test than male trainees. While the attitude of senior and junior trainees was similar, more of the latter group worked in public clinic that provide better support where there is better support for outpatient anticoagulation treatment (e.g., same-day INR test, direct access echocardiogram, and warfarin in in-house pharmacy).

Conclusion: Vocational training in family medicine appears to improve primary care physicians' knowledge regarding the management of AF. Better knowledge will help vocationally trained primary care physicians to provide anticoagulation treatment for AF within primary care clinics. More optimal AF management within primary care can take place if the identified barriers are addressed and a shared care plan can be implemented.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.