A simulation-based biodefense and disaster preparedness curriculum for internal medicine residents

Abstract

Aims: Disaster and bioterrorism preparedness is poorly integrated into the curricula of internal medicine residency programs. Given that victims may present to a variety of healthcare venues, including primary care practices, inpatient hospital wards, and intensive care units, we developed a curriculum to address this need.

Methods: The curriculum consisted of four didactic sessions with supplemental readings covering biologic, chemical, and radiologic agents, as well as public health infrastructure. All 30 internal medicine resident participants also underwent a four hour training seminar at a high fidelity human simulation center. Instruction included the use of personal protective equipment (PPE) and participation in simulated scenarios utilizing technologically sophisticated mannequins with monitoring and interactive capability. Sessions were videotaped, reviewed with participants, and followed by self-evaluation and constructive feedback.

Results: Compared to a control group of residents who did not undergo training, the participants’ level of knowledge was significantly better, with mean objective test scores of 66.8% ;± ;11.8% SD vs. 50% ;± ;13.1% SD, p ;< ;0.0001. Although there was a trend toward increasing knowledge with increasing level of training in the control group, this difference was not significant. Subjective preparedness was also significantly better in the intervention group (p ;< ;0.0001). Objective improvements were not maintained after one year.

Conclusions: In this pilot study, a disaster-preparedness curriculum including simulation-based training had a positive effect on residents’ knowledge base and ability to respond to disaster. However, this effect had diminished after one year, indicating the need for reinforcement at regular intervals.

Additional information

Notes on contributors

Eleanor M. Summerhill

ELEANOR M. SUMMERHILL, MD is the Director of the Internal Medicine Residency Program and an Assistant Professor of Medicine in the Division of Pulmonary and Critical Care Medicine at Memorial Hospital of Rhode Island and the Warren Alpert Medical School at Brown University.

Milan C. Mathew

MILAN C. MATHEW MD, MPH is a Senior Resident in the Internal Medicine Residency Program at Memorial Hospital of Rhode Island and the Warren Alpert Medical School of Medicine at Brown University. He obtained his MPH in Epidemiology from the University of Massachusetts Amherst and has prior experience with the Cochrane Collaboration.

Sally Stipho

SALLY STIPHO, MD is currently a Gastroenterology fellow at the Carl T. Hayden VA Medical Center in Phoenix, Arizona. She is a former Chief Medical Resident and Assistant Instructor in Medicine at the Memorial Hospital of Rhode Island and the Warren Alpert Medical School at Brown University.

Andrew W. Artenstein

ANDREW W. ARTENSTEIN, MD is the Physician-in-Chief of the Department of Medicine and Director of the Center for Biodefense and Emerging Pathogens (CBEP) at Memorial Hospital of Rhode Island. He is an Associate Professor of Medicine and Community Health at the Warren Alpert Medical School at Brown University.

Liudvikas Jagminas

LIUDVIKAS JAGMINAS, MD is the Physician-in-Chief of the Department of Emergency Medicine at Memorial Hospital of Rhode Island, and an Assistant Professor of Emergency Medicine at the Warren Alpert Medical School at Brown University. He is the past Assistant Director of the Disaster Medical Training Institute of Rhode Island.

Patricia M. Russo-Magno

PATRICIA M. RUSSO-MAGNO, MD is a Clinical Intensivist and Pulmonologist at Memorial Hospital of Rhode Island. She is a Clinical Assistant Professor at Warren Alpert Medical School of Medicine at Brown University. She served as Instructor of Medical Readiness Training in Biological and Chemical Warfare in The United States Air Force.

Susan Potter

SUSAN POTTER, RN, MA is the Educational Coordinator for the Internal Medicine Residency Program, Memorial Hospital of Rhode Island. She is a Clinical Teaching Associate at the Warren Alpert Medical School at Brown University. She is actively involved in curricular development as well as medical education research.

Marc J. Shapiro

MARC J SHAPIRO, MD designed and founded the Rhode Island Hospital Medical Simulation Center in 2002, acted as center director for the first three years of operation, and currently serves in a consultant role. He is an Associate Professor of Emergency Medicine at the Warren Alpert Medical School at Brown University.