To the Editor:
Calls to develop skill-based competencies for emergency preparedness for health professionals—including physician trainees—predate the terrorist attacks of September 11, 2001. In June 2001, an American College of Emergency Physicians task force recommended that residents and medical students achieve proficiency in bioterrorism and weapons of mass destruction.Reference Waeckerle, Seamans and Whiteside1 Unfortunately, in the years following the 9/11 terrorist attacks, emergency preparedness education assessment largely focused on practicing physicians and not trainees.Reference Gershon, Qureshi and Sepkowitz2–Reference Lanzilotti, Galanis and Leoni5
In 2003, the Association of American Medical Colleges and the Institute of Medicine published reports encouraging early introduction of bioterrorism topics in medical school. The Association of American Medical Colleges report Training Future Physicians about Weapons of Mass Destruction was the first to detail a vertical integration of bioterrorism curricula into all 4 years of medical education.6 In response to these reports, medical schools increased the attention paid to bioterrorism topics. In 2004, of 125 US medical schools, 104 reported that “biological/chemical terrorism” was included in ≥1 required medical school courses.7
Yet US medical schools have been slow to develop stand-alone curricula that capture the academic breadth of disaster medicine. For example, a search of the Association of American Medical Colleges Course Details database using the terms “disaster,” or “preparedness,” or “casualty,” or “bioterrorism,” or “triage,” revealed only 2 courses with any of the above terms in their title.8 With the exception of the notable work from some of our public health educators—for example, those at Columbia University—few medical schools have implemented core competencies for all health professionals in emergency preparedness such as those recently advocated by the American Medical Association's Expert Working Group.Reference Subbarao, Lyznicki and Hsu9
Thus, disaster medicine and emergency preparedness remain peripheral components of traditional medical education in the United States. Research on this topic is also lacking. We found only 2 published articles that specifically address the feasibility and efficacy of implementing disaster training to medical students.Reference Coico, Kachur and Lima10, Reference Parrish, Oliver and Jenkins11
To address this research and training gap, we developed a 3-hour educational demonstration project to determine whether there was a novel method to teach medical students key concepts of disaster medicine. Using a pre-/posttest design, we measured the extent to which fourth-year medical students perceive, rapidly learn, and apply basic concepts of disaster medicine and emergency preparedness.
We sought to introduce concepts of disaster medicine immediately without the necessity of seeking university approval for a new course or changing an existing course. An application was submitted to the Office of Medical Education to offer our course, “Disaster 101,” as an elective for fourth-year medical students.
An expert curriculum panel was convened consisting of 4 emergency medicine faculty physicians along with paramedic, emergency management, law enforcement, education, and training experts from the South Carolina Allied Health Education Consortium. The primary goal of the expert panel was to condense dozens of hours of existing lecture material into just 3. Via a modified Delphi technique, the panel pared down hundreds of competencies and competency domains into just 8. In addition to a 90-minute didactic, 2 performance-based training exercises were developed. These included a hazardous material scene where students dressed and decontaminated a patient exposed to a toxin and a surprise mass casualty incident scenario with 100 life-sized mannequins.
Nearly all of the students who completed the 3-hour course accomplished their mass casualty incident performance objectives, improved upon their pretest scores, and rated their overall knowledge as significantly improved after the course. Students rated the disaster training extremely highly. In fact, “Disaster 101” was one of the highest-rated courses in the 2008 fourth-year selective.
Overall, we used existing resources and local expertise and showed that fourth-year medical students can learn basic concepts of disaster medicine in a short period of time. We also did this without undermining the content or limiting the length of a single medical school course. The results of this educational demonstration project reveal that students will value and can rapidly learn some core elements of disaster medicine and emergency preparedness via a novel addition to a medical school's curriculum. We believe the principle of a highly effective and well-received medical student course that can be added without undermining current curriculum has been demonstrated here. Further research is needed to validate core competencies and performance-based education goals for all health trainees.
Lancer Alan Scott, MD
Medical University of South Carolina
