Med school teaches bioterror response

AAMC cites program as a model

The bioterrorism training program at the University of Pittsburgh School of Medicine, among the first of its kind in the nation, has been described as a model by the Washington, DC-based Association of American Medical Colleges (AAMC) during its recent annual meeting.

The program integrates level-appropriate content throughout the four-year medical school curriculum, placing the appropriate content into existing courses and evaluations. Students are taught how to identify, triage, and treat patients exposed to biological, chemical, and radiological terrorism, emerging infectious diseases, and environmental pollution. They also are taught about food and water source safety, the impact of pharmaceutical treatments, terrorist hoaxes, and technologic threats to the continuity of public and health services.

Officials from the school currently are working to help foster benchmarking in other medical teaching facilities in an effort to better prepare health care professionals to deal with potential future biodisasters.

"This type of content has always been included in med school curricula," notes John D. Mahoney, MD, assistant dean for medical education. "But when I learned about it in the ’80s, it was as history — anthrax was about sheep handlers, and the military worried about chemical weapons. Military medical school had hundreds of hours of classes, while we had snippets."

But when Mahoney developed the current curriculum, he brought to the process his background as an emergency physician and toxicologist.

"Disaster response is about getting out there and getting your hands dirty. I was used to thinking about all of the bad things that could happen — and helping our hospital plan for them. As we headed toward Y2K, as the rest of the country was increasingly worried about threats of chemical weapons, I felt we should cover them in our curriculum," he explains.

Mahoney’s first steps were deliberately gradual. The first move involved one hour in the classroom and a couple hours of independent work, blended into the usual curriculum. "We brought it into the clerkship in internal medicine in 2000, just like any other subject," Mahoney notes. "We did it quietly — on purpose. We wanted to quietly introduce the subject as an ordinary topic of 21st century medicine. As such, the students accepted it as a reasonable thing to learn about."

The first course began in July 2000. "More than a year later, the anthrax attacks occurred, and students were saying, It’s a good thing I learned this,’" Mahoney observes.

In August 2002, the school rolled out an "all-threats" approach. "If a hospital has a disaster plan, and it is specialized for anthrax — well, we may never see another anthrax attack; the next time it may be plague," Mahoney explains. "It’s even far more likely a bus will crash or we’ll have several cases of West Nile happen — or there’ll be a GI outbreak on cruise ships."

Accordingly, two key principles are employed to bring out the curriculum:

Prepare for all things.

Make preparedness part of the normal fabric of studying medicine, and reinforce that message again and again.

"It’s the same approach as, say, the one used when a nurse in triage hears a cough," Mahoney says. "They will think TB. They won’t panic, but they’ll think of it."

Level-appropriate content is inserted into courses in the context in which it makes the most sense. "For example, if there’s not enough vaccine to go around, who should get it? That sounds like an ethics course," Mahoney points out.

"We’re not going to have daylong seminars or even hour-long seminars," he continues. "We will infiltrate the introductory courses with a small bit of content. Naturally, the infectious disease course will get a fair bit, but every course will get something. In the applied clinical pharmacology course, which is an advanced course, we might teach about the mechanism of action of chemical agents and antidotes, and so on."

Another consideration would be the public health aspect: How does a community cope with an outbreak? "Part of what we’re teaching doctors is to get them to know their role in a disaster," Mahoney explains.

"Doctors are used to thinking they are in charge, but in a disaster, it may be the mayor or a soldier. Also, they are used to treating a patient. We need to teach a community perspective," he points out. As part of the introductory course, students go into a community and learn to understand its needs.

The key premise of the new approach, says Mahoney, is that every physician has the potential to be the first one to encounter a given situation, but not every physician is a specialist in infectious disease.

"Accordingly, we need to make every one sufficiently knowledgeable so that they can be the proverbial canary in the coal mine," he observes. "They need to be able to recognize that there’s something odd going on, and to know what to do — for example, call the infectious disease department. If all we achieve is getting first responders up to that level, we will have done a lot." Now, Mahoney is helping to spread the approach to other institutions.

"We were approached by the AAMC, who wanted to know how we anticipated’ the bioterror problem, and how others can learn the same things," he recalls. "I was invited to help develop a plan on how to bring curricula like this to other medical schools." There have been several meetings, and interestingly enough, what Mahoney and his colleagues have proposed is right in keeping with the thinking of the Centers for Disease Control and Prevention.

"Our goal is to have all medical personnel brought up to a certain basic level of competence to approaching these events — knowing the first steps, and then beyond that knowing how to work with a team of experts," Mahoney concludes.

Need More Information?

For more information, contact:

  • John D. Mahoney, MD, Assistant Dean for Medical Education, University of Pittsburgh Medical School. Telephone: (412) 648-8714.