title: A simulation-based biodefense and disaster  preparedness curriculum for internal  medicine residents.
abstract: OBJECTIVE
  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.
authors.affiliation: Internal Medicine Residency Program, Department of Medicine, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA. eleanor_summerhill_md@brown.edu
authors.forename: Eleanor M
authors.initials: EM
authors.lastname: Summerhill
authors.forename: Milan C
authors.initials: MC
authors.lastname: Mathew
authors.forename: Sally
authors.initials: S
authors.lastname: Stipho
authors.forename: Andrew W
authors.initials: AW
authors.lastname: Artenstein
authors.forename: Liudvikas
authors.initials: L
authors.lastname: Jagminas
authors.forename: Patricia M
authors.initials: PM
authors.lastname: Russo-Magno
authors.forename: Susan
authors.initials: S
authors.lastname: Potter
authors.forename: Marc J
authors.initials: MJ
authors.lastname: Shapiro
mesh_terms: D023482:Bioterrorism; D003162:Competency-Based Education; D054597:Disaster Medicine / Q000193:education*; D004189:Disaster Planning / Q000379:methods*; D004503:Education, Medical, Graduate / Q000379:methods*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency; D016544:Patient Simulation; D010865:Pilot Projects; D018794:Problem-Based Learning