In this era of increased national bioterrorism awareness, training physicians to recognize and respond to potential biological and chemical events has not yet been well integrated into the curriculum of Internal Medicine residency and fellowship programs. Given that victims of bioterrorism may present to community-based primary care physicians, hospitalists, or Critical Care specialists as well as Emergency Medicine providers, programs must address this deficit. This project was a collaborative effort between members of the divisions of Pulmonary and Critical Care Medicine, Infectious Diseases, and Emergency Medicine at Brown Medical School, and was designed to develop a Biodefense curriculum for Internal Medicine residents at one of the major teaching affiliates.
The curriculum consisted of a series of 3 lectures pertaining to biological, chemical, and radiologic agents, as well as public health emergency infrastructure. A manual of selected reading was also provided. All residents in the program subsequently participated in a 4 hour training seminar. Instruction included the use of personal protective equipment (PPE), and participation in simulated Emergency Department and Intensive Care Unit scenarios utilizing sophisticated mannequins with monitoring and interactive capability on whom a number of invasive procedures may be performed. These sessions were videotaped and followed by constructive feedback.
Pre and post self-assessments of knowledge and skill level were performed, as well as objective medical knowledge testing. 22 of 30 participating residents responded to the questionnaire and performed the examination (73%). All respondents agreed that the experience was beneficial. Major findings were as follows:
Our curriculum had a positive effect on level of awareness, skills, and knowledge base in Biodefense. Future goals include achieving a higher level of competence among trainees attending these sessions and assessment of long term retention of knowledge and skill sets.
The addition of a curriculum in Biodefense to Internal Medicine residency and fellowship training programs will better enable future primary care and subspecialist physicians, in particular intensivists, to recognize and respond appropriately to potential biologic and chemical events.
Self-assessment: Knowledge of biologic agentsPRE (% of residents)POST (% of residents)None31.84.5Minimal63.645.5Some040.1Moderate00Excellent00n/a4.59.1
Sally Stipho, None.