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    Don’t touch that lettuce: Battling a foodborne illness outbreak

    Each year, foodborne illnesses sicken roughly 48 million people. A new online module teaches health professions students how to collaborate to help handle an outbreak.


    It starts innocently enough: a boy and his mom have diarrhea and a slight fever. Fourteen days later, it’s clear they’re part of a salmonella outbreak that has struck more than 100 people. By the time it’s over, hundreds will have been hospitalized and several people will have died.

    Although the patients in this case study are fictitious, the deadly outbreak was very real, hitting 40 states in 2015.

    What’s more, foodborne illnesses kill 3,000 people in the United States and sicken 48 million each year, estimates the Centers for Disease Control and Prevention (CDC). Sometimes, they’re isolated cases, like when your potato salad sits in the sun too long. But when these illnesses might be part of an outbreak, health professionals need to work together effectively to find the cause and help prevent further spread.

    That’s why four academic organizations created the first-ever online module that teaches medical, nursing, and public health students how to collaborate to contain a foodborne outbreak.

    Released this summer, Navigating a Foodborne Outbreak: Preparation for Interprofessional Practice is the handiwork of the CDC-led Academic Partnerships to Improve Health (APIH), an initiative that includes the AAMC, the American Association of Colleges of Nursing, the Association for Prevention Teaching and Research, and the Association of Schools and Programs of Public Health. The self-paced, video-based lessons fill a crucial need, says LaVonne Ortega, MD, MPH, APIH program director.

    "Most providers will encounter foodborne illness at some point in their practice — and some will encounter it multiple times," says Ortega. “It’s important for them to be skilled in working with other disciplines and health departments to prevent the illness from spreading. This module provides students the opportunity to learn how to do that from a simulated case, before they’re confronted with a case in real life.”

    And the module teaches skills that go well beyond foodborne illness, notes Sherese Johnson, MPH, AAMC director of public health initiatives.

    “Most providers will encounter foodborne illness at some point in their practice. … It’s important for them to be skilled in working with other disciplines and health departments to prevent the illness from spreading.”

    LaVonne Ortega, MD, MPH
    Program Director, CDC Academic Partnerships to Improve Health

    “In today’s changing health care landscape, we’re moving increasingly to team-based care and interprofessional practice,” notes Johnson, the AAMC’s lead for CDC-funded initiatives. “We believe it’s essential for future physicians to understand different professionals’ roles, so they can work together to help protect people’s health.”

    The germ of a lesson

    “Have either of you been traveling? [Eating] raw or undercooked meat?… How about swimming in lakes or rivers?” As an early module scene opens, the clinic’s doctor and nurse both explore whether the woman and her son could have an infectious illness. The mother reports nothing unusual, but they’re told to get stool tests anyway. Why? She works in a senior center’s kitchen and the boy attends daycare, places where germs could quickly spread.

    Three days later, the lab contacts the local public health department to report that the two have been infected by the potentially dangerous salmonella poona.

    Soon the department’s communicable diseases nurse is investigating possible connections between various cases, and the doctor’s office provides the mother’s phone number. But doesn’t that breach privacy protections? Actually, health professionals can share information without a patient’s permission if it’s part of a public health investigation, the module notes.

    In short order, department staff are setting up a command center and preparing for more in-depth epidemiological sleuthing.

    This whole story line — detailed in the online module — takes users an hour and a half or two to work through. Along the way, they can take quick quizzes, repeat sections, and jot notes online. They also can delve deeper into optional topics and build a personal library of resources. And although the module is designed for students, it’s also appropriate for practitioners hoping to better understand public health.

    Foodborne feedback

    Jacob Prunuske, MD, MSPH, assistant dean for clinical learning at the Medical College of Wisconsin-Central Wisconsin, tried the curriculum during its testing phase.

    “One of the challenges [in medical schools] is that people sometimes think, ‘Oh, the public health people will take care of that’ without actually having any clue what the public health people do,” says Prunuske. “This curriculum is a way to help our students gain a better understanding of the public health system without having to bring in our local public health nurse or the county health director. It’s a really solid, free, off-the-shelf curriculum … based on very credible sources.”

    He also values the module’s flexibility. “Every school in the country is struggling with the appropriate use of class time — lecture versus module versus small group versus something else,” he says. “I’d rather give students options in terms of when and where they learn the material. Then class time becomes a discussion of the sticky points, or the intricacies, or the application of concepts in a different setting.”

    Everyone at the table

    Creating the module took its own share of interprofessional collaboration.

    The team — which was comprised of medical education consultants, state and local public health department officials, and CDC experts — spent months creating and vetting the module.

    “Throughout this project, we really learned how to collaborate more effectively as academic partners,” Johnson recalls. “Sometimes in the health professions, medicine tends to dominate, but it's not just physicians who impact health — it's the entire team. We wanted to ensure the module offers ways to bridge gaps between clinical and public health practice. And we wanted that teamwork reflected not only in the module itself, but in how we worked with each other.”

    That kind of interprofessional teamwork is represented robustly in the module’s last scenes. A month after the outbreak, key local players meet to discuss possible ways to better handle future crises.

    Such efforts are essential to improving health outcomes, notes Johnson. “Clinicians have to be able to work together with public health departments, local organizations, and other health partners,” she says. “We very much want our students to be prepared to integrate with, understand, and support their communities.”