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'First Contact, First Response'AAMC Panel Releases Report On Bioterrorism EducationAn AAMC panel has released a new report on the need to educate medical students about bioterrorist threats. The panel was formulated in response to Sen. Bill Frist's (R-Tenn.) call for curricular guidelines to prepare future physicians to deal with potential threats in the wake of the anthrax incidents in late 2001. Convened as part of the AAMC's "First Contact, First Response" program, the panel emphasized the importance of educating medical students to detect the presence of weapons of mass destruction (WMD) in the event of being presented with symptomatic patients. It also noted the need to teach students to coordinate with public health officials should an attack occur. Chaired by Lois Margaret Nora, M.D., J.D., president and dean of Northeastern Ohio Universities College of Medicine, the multidisciplinary panel agreed that its suggested curricular guidelines should span all four years of medical school, be integrated horizontally across the curriculum, and consist of a combination of didactic sessions and experiential learning exercises. Early warningsThe report did not explicitly confine its recommendations to "biologic" agents, but took into account chemical, physical, and radiological agents - any threats, the report said, "that may result in mass casualties." The panel agreed that rather than having students acquire knowledge through rote memorization of the characteristics of all destructive agents, educators should focus on "general concepts that distinguish particular classes of agents, their mechanisms of injury, and their containment/treatment." Rika Maeshiro, MD, M.P.H., senior medical research associate in the AAMC's Division of Medical Education, synthesized the panel's work and authored the report. "Panel members recognized the importance of making future physicians aware of the mental health issues associated with bioterrorism," she said. The report opens with a recognition of physicians' central role in the event of a WMD incident. This includes the likelihood of doctors being the first detectors of an attack and publicly regarded "experts" in the proper responses to an attack, resulting in interactions with law enforcement, public health agencies, the media, and their communities. Panel members emphasized the importance of combining the clinical knowledge students must have to be prepared for these roles with the skills to interact within "multidisciplinary teams in the context of WMD preparedness and response." Dr. Maeshiro believes that this is an important opportunity to educate medical students about effectively interacting with the public health system. Recent events, she said, bear this out. "Although they haven't been associated with a terrorist event, SARS and the West Nile virus have highlighted the need for the medical and public health communities to coordinate their activities," Dr. Maeshiro said. "I believe that bioterrorism is a topic through which medical students can become more aware of the public health system, how clinicians must work with and within that system, and their shared responsibilities for disease containment, disease prevention, and health promotion. These are important points for physicians to appreciate, whether in the context of a WMD response, a 'naturally occurring' infectious disease outbreak, or in efforts to prevent and treat chronic diseases or injuries," she said. "The reason the West Nile virus was detected was that physicians recognized an unusual presentation of a medical problem," said Deborah Danoff, MD, associate vice president in the AAMC's Division of Medical Education and chief coordinator of the panel. "It's not an example of bioterrorism, but it is an example of a physician saying, 'Hey, this is unusual. Let me talk to the public health department and find out why it's happening,'" she said. "Tightening that degree of surveillance about unusual events is how many medical schools are approaching bioterrorism education." Science, safety concernsIn outlining recommended learning objectives, the panel addressed the opportunity to include information about the properties of WMD within basic science courses. Within students' clinical training, the panel recommended that they learn how to recognize and treat patients exposed to a WMD agent and how to take precautions to ensure the safety of themselves and others. Panel members also concurred that students' comprehensive understanding of the structure and function of public health systems should be buttressed by an awareness of the role physicians play when those systems respond to emergencies. Finally, the panel addressed the topic of professional ethics, and spelled out what physicians must know about the rights and responsibilities of themselves and their patients. The panel recognized that these activities cannot take place without the necessary materials and faculty to teach them. In addition to recommending a series of Web resources, the panel also gave solid examples of medical schools that have already incorporated bioterrorist response instruction into their curricula. "Many schools have developed individual lectures or incorporated topics into microbiology courses," said Dr. Maeshiro, "and a few schools have taken [bioterrorism education] a step further to integrate it across the curriculum through all four years and link topics across courses, but that is still the minority. We have a long way to go. This is an important first step." - Barbara A. Gabriel |
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