Under its Evidence-based Practice Program, the Agency for Healthcare Research and Quality (AHRQ) is developing scientific information for other agencies and organizations on which to base clinical guidelines, performance measures, and other quality improvement tools. Contractor institutions review all relevant scientific literature on assigned clinical care topics and produce evidence reports and technology assessments, conduct research on methodologies and the effectiveness of their implementation, and participate in technical assistance activities.
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Overview / Reporting the Evidence / Methodology / Findings / Future Research / Availability of Full Report
Recent terrorist attacks against the United States have increased awareness of the Nation's vulnerability to terrorism. One particularly serious form of terrorism involves the use of biological weapons that could cause devastating epidemics.
To minimize the risks of bioterrorism, the United States has made bioterrorism preparedness a priority for government and military agencies, public health advocates, law enforcement, first responders, and health care professionals. Based on the recommendation of a working group led by the Centers for Disease Control and Prevention (CDC), preparation efforts are concentrating on smallpox, anthrax, plague, botulism, tularemia, and the viral hemorrhagic fevers. These agents have been chosen as areas of focus due to their ease of dissemination and transmission, high mortality rates, ability to cause public panic, and need for special public health preparedness.
Until recently, the public and private health care sectors had been largely excluded from the Nation's bioterrorism preparatory efforts. The very group that would handle the consequences of an attack has yet to receive widespread education on the topic. Fortunately, the value of bioterrorism education has been recently recognized, leading to a significant question: How does one effectively train clinicians for such an unusual public health crisis? The purpose of this evidence report is to identify and review data on the most effective ways to train clinicians to respond to a bioterrorist attack or other public health event posing similar challenges to the health care system.
The target population addressed in the studies reviewed in this evidence report consists of clinicians including physicians, physician assistants, nurses, nurse practitioners, and community health workers. The target audience for the report consists of policymakers and others developing educational strategies for health care professionals that could be involved in the assessment and management of victims of a bioterrorist attack.
To identify the most effective methods to train clinicians to respond to a bioterrorist attack, the Johns Hopkins University Evidence-based Practice Center (EPC) addressed the following key questions:
Q1a. What are effective methods for the initial training of clinicians for detection and management of a bioterrorist attack or other public health event?
Q1b. What are effective methods for updating and reinforcing the training of clinicians for detection and management of a bioterrorist attack or other public health event?
Q2. What are effective methods for training clinicians to use Web- or telephone-based central information resources in response to a bioterrorist attack or other public health event?
Q3. What are effective methods for training clinicians to report events to a central agency in response to a bioterrorist attack or other public health event?
Q4. What are effective methods for training clinicians to communicate with other health care professionals in response to a bioterrorist attack or other public health event?
Due to the paucity of literature pertaining specifically to the education of health professionals in bioterrorism preparedness, the EPC sought to include evidence on the effectiveness of training clinicians for other types of public health events with similar training requirements. Distinctive requirements include the ability to rapidly identify unusual disease syndromes, to contact public health officials, and to communicate with disease control agencies as well as other health professionals. The relevant public health events considered in this report were infectious disease outbreaks, toxidromes or mass poisonings, catastrophic events that incite public fear, and events that call for use of hospital disaster plans.
To identify all studies potentially relevant to the key questions, the EPC team searched electronic databases and Web sites and conducted hand searching of references.
The databases searched were:
The team also searched the database of the National Technical Information Service of the United States Government. Hand searching focused on journals that were most likely to have eligible studies, as well as reference lists in key articles. The Internet was searched using the metasearch engine Copernic 2000®. The search covered articles published through June 2001.
For the first step in the review process, two members of the EPC team independently reviewed the titles identified by the search for relevance to the project. All titles deemed irrelevant by both reviewers were excluded from the abstract review process.
Each potentially relevant abstract was circulated to two members of the study team who independently reviewed the abstract and indicated which, if any, of the key questions the article addressed. For articles found not relevant, the reviewers indicated a reason for exclusion.
The exclusion criteria were:
Each relevant article was read by a pair of reviewers using a form to assess study quality and a form to extract information from the article. At least one reviewer had advanced training in research methods and at least one had relevant advanced clinical training. The reviewers evaluated study quality in terms of educational methods, reporting of representativeness, bias and confounding, description of outcomes, and statistical quality. Study quality scores were calculated for each of the five categories based on the percentage of study quality items that were adequately addressed. An overall quality score was calculated as an average of the five category scores. On the content form, the reviewers abstracted the following types of information from each eligible study: learning objectives, characteristics of targeted health care professionals, educational methods, results for each type of learning objective, and conclusions. Data from the article review process were entered into a relational database.
This evidence report highlights the lack of strong published evidence about how to train clinicians for bioterrorism preparedness. Furthermore, there is a paucity of well-designed studies pertaining to the training of clinicians in management of public health events relevant to bioterrorism preparedness. This has significant implications for future research in training health professionals in this area.
To determine the most effective way to train clinicians on how to respond to a bioterrorist attack or other serious public health event, future work will need to give more attention to evaluating the effectiveness of educational programs. Evaluation methods should include pretesting and posttesting, as well as at least one comparison group. The use of measurable outcomes will be critical to ensure unbiased determination of the efficacy of educational strategies. Furthermore, targeted outcomes should be linked to well-defined learning objectives.
The following specific questions are areas for future research. They are vitally important questions to answer and are currently without published evidence.
The full evidence report from which this summary was taken was prepared for the Agency for Healthcare Research and Quality by Johns Hopkins University under Contract No. 290-97-006. Printed copies may be obtained free of charge from the AHRQ Publications Clearinghouse by calling 800-358-9295. Requesters should ask for Evidence Report/Technology Assessment No. 51, Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness.
The Evidence Report is also online on the National Library of Medicine Bookshelf, or can be downloaded as a zipped file.
AHRQ Publication Number 02-E007
Current as of December 2001
Internet Citation:
Training of Clinicians for Public Health Events Relevant to Bioterrorism Preparedness. Summary, Evidence Report/Technology Assessment: Number 51. AHRQ Publication No. 02-E007, December 2001. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/clinic/epcsums/biotrsum.htm
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