# Acquisition of Knowledge and Clinical Skills in Diagnosing Acute Appendicitis Among Medical Students: Contributing Factors and Overall Assessment

## TL;DR

Medical students at Al-Qunfudhah Medical College show good knowledge of typical appendicitis symptoms but struggle with atypical cases and diagnostic tools.

## Contribution

The study identifies factors influencing medical students' diagnostic proficiency in appendicitis, emphasizing the role of clinical exposure.

## Key findings

- Students recognized common symptoms like continuous sharp pain and right lower quadrant localization but had gaps in atypical presentations.
- Clinical exposure correlated significantly with higher knowledge levels, while age, sex, and year of study did not.
- Awareness of complications like peritonitis was low, and knowledge of ultrasound and MRI for diagnosis was moderate.

## Abstract

Background and aim

Acute appendicitis (AA) is one of the most common surgical emergencies and serves as a key indicator of diagnostic proficiency among medical trainees. Variability in clinical presentations, the occurrence of atypical cases, and the ongoing evolution of diagnostic and management strategies can pose significant challenges for undergraduate medical students, particularly those with limited clinical exposure. This study aimed to assess the knowledge and applied clinical reasoning of fifth- and sixth-year medical students regarding the diagnosis and management of AA. The primary objective was to evaluate students’ understanding of classical and atypical clinical presentations, diagnostic approaches, complications, and management strategies. The secondary objective was to identify educational and exposure-related factors associated with variations in knowledge levels.

Methods

A cross-sectional study was conducted from April to August 2025, targeting fifth- and sixth-year medical students at Al-Qunfudhah Medical College. Using universal sampling, a semistructured questionnaire collected sociodemographic data and included 28 questions assessing knowledge and clinical skills related to appendicitis. Data were analyzed using IBM SPSS Statistics for Windows, Version 28.0 (Released 2021; IBM Corp., Armonk, NY, USA).

Results

A total of 100 medical students from Al-Qunfudhah Medical College participated; most were under 24 years of age (55%) and male (63%). Fifth-year students comprised 60% of the sample. Nearly half of the participants (48%) had encountered 10-20 appendicitis cases during clinical rotations. Participants demonstrated strong recognition of key clinical features, including continuous sharp pain (81%), periumbilical pain migration (77%), and right lower quadrant localization (74%). Knowledge gaps were identified in recognizing atypical presentations (56%) and pregnancy-related pain variations (56%). Awareness of diagnostic tools was highest for CT scans (86%) and inflammatory markers (69%), while knowledge of ultrasound (62%) and MRI (57%) was moderate. Students demonstrated good understanding of complications such as bleeding (91%) and abscess formation (83%) but showed less awareness of peritonitis (58%). While 76% preferred surgical management, only 55% supported medical management options. Overall, 49% demonstrated moderate knowledge, 24% high knowledge, and 27% low knowledge. Clinical exposure correlated significantly with higher knowledge levels (p = 0.049), whereas age, sex, and year of study showed no significant associations.

Conclusions

This study demonstrates that medical students at Al-Qunfudhah Medical College have satisfactory knowledge of the classical features and surgical treatment of appendicitis. However, gaps remain in their understanding of atypical presentations, diagnostic tools, and preoperative complications. While students were able to identify common symptoms and postoperative risks, their knowledge was less consistent when applied to varied clinical scenarios encountered in real-world settings.