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AAMC Panel Defining Physician Roles Within Bioterrorism Education

With the recent "Orange Alert" indicating the risk of another potential terrorist attack in the United States, it seems that America's "war on terrorism" may become a way of life for the foreseeable future. The medical community recognizes its new mandate to educate future physicians to practice in a milieu where a physical, biological, chemical, or nuclear attack is an ever-present possibility.

Following the events of Sept. 11, 2001, the AAMC's Division of Medical Education in June 2002 convened a panel, funded by the Centers for Disease Control and Prevention through an AAMC-CDC cooperative agreement, to make recommendations to medical schools about what might be included in medical student undergraduate curricula concerning responses to any potential attack.

Medical schools that are already engaged in adding terrorism-related material to their curricula have served as resources for the panel, which plans to deliver a report containing case histories and curriculum strategies later this spring. Curriculum designers will be able to use the document to review their current offerings and develop new programs appropriate to their educational goals.

The panel agreed at the outset of its discussions that curriculum designers must go well beyond just the issues of bioterrorism, according to Deborah Danoff, M.D., AAMC associate vice president for medical education and liaison to the panel. "'Bio' implies biological agents, but there are many more aspects to a potential attack," she said.

Keeping vigilant

Curriculum changes should cover issues related to a host of terrorist events - including biological, chemical, nuclear, and physical agents -and keep in mind the psychological components surrounding terrorism, including the times when there are no attacks, Dr. Danoff added.

To that end, the panel established that "mass casualties" would be a more inclusive umbrella term for medical schools to use in teaching terrorism response. However, it should be clear that while a terrorist "attack" might imply that injuries would occur all at once, in reality there could be an ongoing progression over time, as in the case of an infectious epidemic.

Physician Roles:

A physician's role, as outlined by the AAMC bioterrorism education panel:

Sentinel
Care-giver
Counselor
Ethicist
Laboratory/diagnosis
Team member:
- Risk assessor
- Messenger

One of the most important roles identified by the panel was that of a physician acting as a sentinel. (See box.) A stealthy biological attack may come to light only after a physician has treated people in the same time frame with similar flu-like symptoms, as was the case, for example, when the non-terrorism-related West Nile virus outbreak was first detected two years ago.

The panel noted that schools probably would not have to develop entirely new clinical materials related to bioterrorism, because elements of the bioterrorism education curriculum are already taught but in a different context.

To that extent, the panel concurred, future physicians need to be prepared for their role as crisis counselors for their patients. They will be called on to help people understand what to do in the event of an attack, while also being ready to diagnose and treat any consequences, according to the panel.

While students must learn the medical facts surrounding any mass-casualty episode, they must also understand how the public health infrastructure will swing into action. "There will need to be a pulling together of the medical, public health, and first-responder communities," Dr. Danoff said. "Medical students will need to learn how to work within teams of existing networks and public-health organizations."

They must also learn how to deal with messages related to risk. "We saw this during the anthrax attacks" that followed 9/11, she added. "There were, at times, conflicting messages coming from the healthcare community about who was at risk, and why and what to do. Physicians need to understand how to work with first responders and others to develop systems and processes of communication for both prevention and containment."

By Martha Frase-Blunt, special to the AAMC Reporter