Innovations in Medical Education: Teaching Contagious Disease Outbreak Awareness to Medical Students and Residents

Larissa May, M.D.Department of Emergency Medicine

The George Washington University School of Medicine

Teaching Contagious Disease Outbreak Preparedness

– Emergency department personnel should be competent at contagious disease outbreak detection and management.

– Given the emphasis on emerging infectious diseases and the threat of biowarfare, there is great need to develop instructional methods on these topics.

The Educational Methods

The workshop is held in a hospital conference room, with the availability of internet, telephone, and other hospital resources, simulating “real-life”.

A hypothetical case of Ebola presenting to an emergency department is outlined.

Participants are then divided into small groups representing the ED physician, the local health department, the CDC, Hospital Administration, the Hospital Epidemiologist, and the Laboratory Director.

Educational Methods

Each group has 30 minutes to define their roles and responsibilities in preparation for the hypothetical outbreak.

A companion manuscript outlining principles of outbreak detection, surveillance, reporting and containment is provided.

After the small group sessions, each group presents and rationalizes their approach to and responsibilities in responding to the outbreak.

The faculty facilitator then gives a 60 minute lecture.

Educational Methods

Pre and post workshop surveys have indicated the workshop is considered useful.

We believe the format of this workshop is easy to reproduce and can serve as a foundation for a curriculum in emerging infections and communicable disease management, and can easily be applied to other educational topics.

The Contagious Disease Outbreak

Workshop: Clinical Case

28 year old previously healthy female biologist presents with fever and spreading rash

Two days ago she developed a fever, sore throat, and vomiting

She has had several very dark bowel movements Today her boyfriend noted she was drowsy and

disoriented She returned from Uganda 3 days ago, where she

was collecting samples from wild monkeys for DNA analysis

Clinical Case

Vitals: 84/52 HR 132 T 104.4 94% RA diaphoretic

Tachypneic with bilateral bibasilar rales Centripetal maculopapular rash with hemorrhagic

erythema on the palms and soles Subconjunctival hemorrhages, palatal petechiae Diffuse abdominal tenderness with guarding; black

stool

You are the only physician working in the Emergency Department…

The nurse notifies you that you have two urgent incoming calls

EMS is transporting a 44 year-old diplomat with massive GI and gingival bleeding, febrile to 102, blood pressure of 60/palp

On the other line a concerned internist is sending two returned travelers with fever and rash

Objectives

How do we recognize potential sentinel cases for an outbreak?

How do we report a suspected outbreak? What measures can we take toward

outbreak containment in the emergency department?

What resources are available in the event of an outbreak?

Workshop

ED physician Local health department National health office (CDC) Hospital administration (Incident

command) Infection control officer Laboratory

Workshop

Each small group of 2 or 3 students uses the companion manuscript, internet, telephone and hospital resources to define their roles and responsibilities in preparing for an outbreak

The small group research takes 30 minutes The groups then convene and a representative

from each focus group discusses their findings A faculty member facilitates this discussion

Lecture

The faculty facilitator gives a 60 minute lecture on the following topics:– Outbreak Epidemiology and Recognition– Syndromic Surveillance– Outbreak Reporting– Outbreak Containment and Hospital Response

Plans– Infection Control Guidelines– Clinical Case Discussion

Clinical Case: Conclusion

A tentative diagnosis of viral hemorrhagic fever is made

Patients placed in airborne isolation, cohorted with staff

You call Infectious Disease on Call and Hospital Administration for activation of the Contagious Disease Outbreak Plan

You notify the DC DOH emergency hotline and the CDC for recommendations and assistance in containment of the outbreak and contact tracing

Identification and confirmation of Ebola serotype made by USAMRIID BSL 4 laboratory

Outbreak Preparedness: Goals for Clinicians

Be familiar with epidemiologic criteria for sentinel cases

Know your hospital emergency preparedness plans and how to report a suspected sentinel case

Follow basic principles of isolation, infection control, and cohorting in an outbreak

Summary: Workshop Materials

Clinical Case Companion Manuscript “Emerging and Re-Emerging

Infections: Public Health Preparedness: Introduction to Infectious Outbreak Reporting and Containment”

Powerpoint Lecture Pre and Post Workshop Surveys For more information, contact Larissa May at

larissa@gwu.edu Note: this is not a commercial product