Medical students graduate with barely any vaccine education, study of 708 course guidelines reveals

When a patient asks a future doctor, nurse, or pharmacist whether a vaccine is safe, the answer that healthcare professional gives can tip the decision. Public health researchers have long argued that clinicians are among the most trusted voices in vaccination, which makes the quality of vaccine training in health-related degree programs a matter of life-and-death consequence. A new study from a Chinese medical university suggests that this training is startlingly thin: of 708 undergraduate curriculum guidelines examined, only 30 — 4.2 percent — explicitly documented any vaccine-related content at all.

The research, published in BMC Medical Education, was led by Zixin Wang and Aiping He, co-first authors based in the Department of Health Services Management at Anhui Medical University in Hefei, China, with a team spanning the university’s Institute of Medical Education, a Hefei hospital, and the Johns Hopkins Bloomberg School of Public Health. The investigators set out to answer a deceptively simple question: how much vaccine science do undergraduate health professions students actually encounter in their formal coursework, and what do they think about it?

To find out, the team used a two-phase explanatory sequential mixed-methods design with triangulation. In the first phase, conducted between March and May 2025, they collected 708 curriculum guidelines from the medical university in Anhui province. After screening and systematic content extraction, they descriptively analyzed the distribution, proportion, and topical coverage of vaccine-related material across the documented curriculum. In the second phase, from June to July 2025, they conducted semi-structured interviews with 23 senior students who had completed their undergraduate coursework and had either finished or were finishing their required graduation internships under those same guidelines.

The quantitative findings are stark. Across the 30 guidelines that did mention vaccines, the median length of the teaching-related sections was 7,894 Chinese characters, with an interquartile range of 5,505 to 10,989 and a full range of 1,482 to 24,080 characters. The median length of vaccine-related content within those sections, by contrast, was just 49 Chinese characters — an interquartile range of 17 to 89 and a range of 10 to 146. In other words, where a course guideline devoted nearly 8,000 characters to teaching, the portion addressing vaccines amounted to a sentence or two.

The proportions tell the same story from a different angle. The median proportion of vaccine-related content across the 30 guidelines was 0.7 percent, with an interquartile range of 0.2 to 0.9 percent and a range stretching from 0.1 to 10.0 percent. In 24 of the 30 guidelines — 80.0 percent — vaccine-related content accounted for less than 1 percent of the teaching-related character count. The study site’s formal curriculum, as documented, explicitly recorded limited vaccine-related material and relatively narrow teaching approaches.

The interview phase added texture that character counts alone cannot capture. From the 23 conversations with senior students, the researchers identified four themes: vaccine cognition and risk perception; assessment of vaccine education; professional role identity and learning expectations; and acquisition and identification of vaccine information. The themes suggest that students were not indifferent to the subject — they were navigating confusion about vaccines, forming views on how the topic had been taught, weighing their future professional responsibilities, and figuring out where to get and how to judge vaccine information on their own.

Interview data further indicated that some students perceived gaps in practical preparation and vaccine-related learning support. This matters because the study’s premise rests on a well-established observation: healthcare professionals’ recommendations can influence public vaccination decisions, yet insufficient vaccine-related literacy and hesitancy among healthcare professionals themselves remain persistent challenges. If the professionals of tomorrow are left to assemble their vaccine knowledge from fragments, the risk is not merely academic — it is that hesitant or under-informed clinicians may pass that uncertainty along to patients.

The timing is significant. Vaccine hesitancy has been flagged by global health authorities as a threat to hard-won immunization gains, and the COVID-19 pandemic demonstrated both the power of vaccines and the fragility of public trust. China’s research in this specific field — examining how vaccine education is embedded in undergraduate health-related curricula — remains limited, which is precisely the gap the Anhui team sought to address. Their study is among the first to combine a systematic audit of curriculum guidelines with student perspectives at a Chinese medical university.

The methodological choices deserve attention. The explanatory sequential design means the quantitative audit came first and shaped the qualitative follow-up, allowing the interviews to probe and explain what the document analysis revealed. Triangulation — comparing the documented curriculum against student experiences — strengthens the conclusions, because a gap that appears in both the official guidelines and the students’ own accounts is harder to dismiss. The study received ethical approval from the Biomedical Ethics Committee of Anhui Medical University, and oral informed consent was obtained from all interview participants before recording began.

The authors’ conclusions point toward concrete remedies. Educational institutions, they suggest, could consider strengthening vaccine education by making learning objectives and core content more explicit in curriculum guidelines, broadening vaccine-related topics, diversifying teaching approaches, and enhancing practical competency development. The findings help clarify potential directions for further optimizing the documented curriculum. Whether other Chinese medical universities — and programs elsewhere — show similar patterns is an open question, but the study offers a template for finding out: audit the guidelines, count the characters, and then ask the students what they were never taught.

Subject of Research: Vaccine education in undergraduate health-related curricula at a Chinese medical university

Article Title: Vaccine education in undergraduate health-related curricula: a mixed-methods study based on curriculum guidelines and student perspectives from a Chinese medical university

Article References: Wang, Z., He, A., Yang, Y., Zhang, X., Yao, L., Wang, Y., Zhou, R., Wang, L., Chen, R., & Zhang, X. (2026). Vaccine education in undergraduate health-related curricula: a mixed-methods study based on curriculum guidelines and student perspectives from a Chinese medical university. BMC Medical Education. https://doi.org/10.1186/s12909-026-10642-8

Image Credits: AI Generated

DOI: 10.1186/s12909-026-10642-8

Keywords: vaccine education, medical curriculum, vaccine hesitancy, health professions students, mixed-methods study, medical education, Vaccine, education, undergraduate, health-related, curricula, mixed-methods