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Study: Many Medical Residents Unable to Diagnose Bioterror Illnesses

Early recognition of a terrorist attack with biological agents will rely on physician diagnosis, but a new study published in the Archives of Internal Medicine found that approximately half the medical residents at 30 internal medicine programs across the country could not diagnose diseases due to bioterrorism agents.

"Physician diagnosis and management of diseases caused by bioterrorism agents is poor. An online [education] module may improve diagnosis and management of diseases caused by these agents," the study authors, who are with the Divisions of Infectious Disease and General Internal Medicine, Department of Medicine, The Johns Hopkins University School of Medicine, Baltimore.

The study, which ran for a year and ended in June 2005, was trying to determine physicians' ability to diagnose and care for patients presenting after a bioterror event. The role of online case-based didactics to measure and improve knowledge in the diagnosis and treatment of these patients is unknown.

For the study, a multicenter online educational intervention was completed by 631 physicians at 30 internal medicine residency programs in 16 states and Washington, DC, between July 1, 2003, and June 10, 2004. Participants completed a pretest, assessing their ability to diagnose and manage potential cases of smallpox, anthrax, botulism and plague. An educational module reviewing diagnosis and management of these diseases was then completed, followed by a post-test. Pretest performance measured baseline knowledge. Post-test performance compared with pretest performance measured effectiveness of the educational intervention. Results were compared based on year of training and geographic location of the residency program.

Correct diagnoses of diseases due to bioterrorism agents were as follows: smallpox, 50.7 percent; anthrax, 70.5 percent; botulism, 49.6 percent; and plague, 16.3 percent, for an average of 46.8 percent. Correct diagnosis averaged 79 percent after completing the education module.

Correct management of smallpox was 14.6 percent; anthrax, 17 percent; botulism, 60.2 percent; and plague, 9.7 percent, for an average of 25.4 percent. Correct management averaged 79.1 percent after completing the education module.

"The significant improvement in posttest scores among respondents at all levels of training suggests that physicians can be trained using an online case-based format to learn how to diagnose and manage infection caused by category A bioterrorism agents," said the study authors.

Attending physicians performed better than residents, causing the study authors to note that the fact did not improve among house staff and faculty based on year of training "may indicate that education of physicians is not occurring during residency training. Attending physicians also may have scored higher than residents because of greater familiarity with the common disorders that have clinical overlap with illnesses due to bioterrorism agents rather than knowledge of bioterrorism syndromes."

Performance did not differ based on year of training or geographic location, and the lack of differences in scores from programs in the New York City and Washington, DC, areas compared with programs in other locations "suggests that no additional emphasis is placed on bioterrorism training in areas that have previously been affected by terror and bioterror events," noted the authors.

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