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Coico, R, Kachur, E, Lima, V, and Lipper, S. Guidelines for preclerkship bioterrorism curricula (2004). Academic Medicine, 79, 366-375. Reviewed by J.E.Fischel

Coico, R, Kachur, E, Lima, V, and Lipper, S. Guidelines for preclerkship bioterrorism curricula (2004). Academic Medicine, 79, 366-375.

Reviewed by J.E.Fischel

Drs Coico, Kachur, Lima and Lipper set the context for this work in the shift over time in personnel deemed to be important to preparedness for health care responses to bioterrorism and biowarfare. Initially seen as a military health care responsibility, and then enlarged to include emergency medical personnel, the relevant personnel are now viewed as broader based in health care trainees. The importance of curricula to address the critical knowledge, skills, and attitudes related to health concerns of bioterrorism is seen by the authors as essential to preclerkship medical training. The study uses an internet-based Delphi survey to question and prioritize topics of importance to preclinical curricula. The Delphi survey provides questions to a broad set of experts as a "reference group" and then summaries, provides consensus, and sends out "next round" of questions with feedback on the earlier responses; with multiple iterations, the authors note, one can gain consensus on multifaceted issues such as curriculum and evaluation strategies.

Why is this paper important to pediatric clerkship leaders? There are two reasons to read the report and contemplate its relevance; one is process and one is content. First, the article provides an exemplary model of a process for getting from step 1 to step 2 and onward in curriculum development, or in any other broad and complex scope of work in which consensus is probably a good thing to achieve. With little prior knowledge of the Delphi survey method, I headed to the internet and learned a great deal more. In the Coico et al. work, a study team set out to develop educational guidelines, albeit focused on preclinical teaching and learning. Next, experts in an array of pertinent fields (e.g., biowarfare, bioterrorism, public health, immunology, microbiology, the CDC) weighed in, converging on a consensus of what needs to be taught and how training should proceed. As a recheck and comparison, medical school microbiology and immunology chairs were queried, identifying topics given inadequate or inconsistent coverage, such as smallpox virus. Finally, the method of consensus development distilled learning objectives in six bioterrorism-related curriculum categories for preclinical teaching and learning.

The second, or content reason this paper is relevant, is found in reflecting back on our curriculum objectives or competencies for the clerkship in pediatrics. Are there implications for undergraduate pediatric education here? Some schools have already launched larger or smaller, targeted or longitudinal efforts in regard to training health care professionals to address bioterrorism/biowarfare, but the examples offered would suggest that many have not. Further, the authors of this research are sensitive to curriculum crowding and the need for restraint. However, they have also provided a stepping stone, by sketching curricular objectives, and by contemplating teaching and assessment strategies, allowing clinical clerkship leaders to consider building on the focused preclinical report. The work is informative, makes one think, and is relevant to COMSEP efforts in preparing physicians successfully for important and perhaps previously less well mapped roles in health care, relating well to anticipatory guidance, prevention, and disease containment models in pediatrics.

(Does your school have a specific curriculum on disaster preparedness? Steve Miller)

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