Developing Disaster Preparedness Competence: An Experiential Learning Exercise for Multiprofessional Education.
Background: The hurricane disasters of 2005 and the threat of pandemic infectious diseases compel medical educators to develop emergency preparedness training for medical students and other health care professional students. Description: This article describes an experiential exercise for learning a number of the general core competencies in the 2003 AAMC report titled "Training Future Physicians about Weapons of Mass Destruction." A modified tabletop exercise for medical and veterinary students, which was developed and implemented in 2005, is described. The exercise focused on Highly Pathogenic Avian Influenza (HPAI), an emerging infectious disease that raised the possibility of biological attack. The students were assigned roles in small groups, such as community physicians, hospital personnel, public health officials, veterinarians, school nurses, and emergency managers. Fifteen faculty members were recruited from these various areas of expertise. Pre- and posttesting of medical students showed significant gains in knowledge. The authors describe the scenario, small-group role playing, study questions, injects, Web sites and readings, and evaluation tools. Conclusions: This experiential exercise is an effective, inexpensive, and easily adapted tool for promoting multiple competencies in mass health emergency preparedness for a variety of health care students including medical, veterinary, public health, and nursing students.
The exercise had three evaluation processes. First, a criterion referenced written test on the content of the lectures, prereadings, and exercises to measure the extent to which the first objective, understanding key concepts, had been accomplished. The pretest and posttest were identical, and at the debriefing, before the posttest, we went over the answers to the questions. We believed that this would reduce stress and, by multiple repetitions of key points, serve as a tool to teach thepoints we wanted the students to remember. The results of the pretest and posttest were analyzed by paired t tests (two-tailed) using SPSS software.Second, written and verbal comments from the students and facilitators about their experience were requested. The third measure was an attitude scale, whose purpose was to assess changes in student attitudes about working with other professionals and about their roles in a disaster. The analysis of these results revealed that the attitude instrument did not have adequate reliability, and thus we do not have valid data regarding the attainment of Objective 4.
Table top exercise, per-/post-testing
The exercise was designed for use with multi-professional students: medical, public health, nursing, and veterinary students. The primary target audience was 2nd-year medical students who did not yet have extensive clinical experience.The consisted of one confirmed HPAI fatality of a poultry science student and two other possible, non-confirmed student cases, with n.a. given about disease in birds. The scenario was deliberately ambiguous about whether the disease was natural or deliberately introduced. In addition to the clinical response, which is the usual focus of training for health professionals, this created the need for involvement of human and animal disease surveillance and disease containment measures, law enforcement investigation, and public information. The scenario was also tailored to the specific characteristics of the Texas A&M University community, which is the “patient” in this outbreak, including its rural setting and correspondingly limited local medical resources.Study questions and “injects” (the technical term for simulated events in an exercise) were developed to guide the students in problem solving and role playing in small groups. Role playing was the means chosen to encourage development of working relationships among health care students. It is one of the educational approaches that has proven effective in multidisciplinary health profession settings and has emerged as a preferred experiential method of learning. The list of recommended pre-readings was developed from written and electronic sources to provide an orientation to emergency management and incident command principles and background information on HPAI. Where possible, these were taken from the Web sites of lead agencies, such as the Centers for Disease Control (CDC) and Federal Emergency Management Agency (FEMA) to promote familiarity with the sites themselves and with other links from these sitesThe deviation: Because of an administrative misstep, the students did not receive the electronic reading list with embedded hyperlinks, and many of these links were lengthy and hard to enter manually. Thus, they had a much harder task to find the online readings than was intended.
The first activity of the 3-hr exercise was the administration of a pretest of knowledge and an attitude scale. Then, the first author (RS) presented a brief lecture with slides emphasizing main points from the prereadings. Afterward, the students divided into their assigned role-playing groups and went to separate work areas. Each work area had a computer, a CD of the prereadings and other reference materials, and an Internet connection. Each group selected a speaker. Then the faculty facilitators gave out three to five injects describing how the put demands on their role and questions for discussion. These injects were different from the pr-estudy questions. Usually, injects are given out sequentially by exercise facilitators as the group progresses through problem solving. In this exercise all of the injects for each 45-min session were given out at the beginning of each session because the time constraints were tight.For the second role-playing session, the groups reassembled in combinations. For example, the groups of primary care physicians, the school district, and the county health department were combined. Again, they received three to five injects to guide discussion of how their group roles interrelate in a health emergency, either for mutual information needs or for the potential to pool resources to address common problems. An inject for the team described here was, “How can you work together to manage large numbers of people who want medical screening and reassurance without flooding emergency rooms?” Faculty guidance suggested guiding the group toward disseminating information to families through schools and possibly setting up screening sites at schools. This session also lasted 45 min.Following the small-group sessions, all the students and faculty members reconvened for debriefing. Each role group and each combination of groups presented a summary of their discussions. These sessions addressed Objectives 2 and 3, practicing and understanding the various stakeholder roles.
Placement of disaster preparedness within the curriculum is important. Curriculum designers and administrators must think carefully about how and where to integrate this new content into existing curriculum.The prereading program was overly ambitious. Prereadings must be carefully selected, prioritized, and made easily accessible to optimize use of participants’ time.The students accurately assessed the weakness of 3 of the 15 facilitators. Few faculty members have deep knowledge of emergency preparedness, a system perspective of their communities, or familiarity with the various response functions.Some of the written comments reflect some students’ expectation that they should be fed information in lectures and told what, out of everything presented, they are required to know for an exam. The exercise was very uncomfortable for these students, as it was deliberately open-ended and required decision making with incomplete information.
In general, the results confirmed the findings from a previous study that a short, 3-hr interactive exercise is sufficient for improving physicians’ knowledge about bioterrorism preparedness. Many of the students found the exercise fun and eye opening. Some students were clearly frustrated. Unexpected student leaders emerged when faced with a novel set of challenges, including students who supported their classmates by simplifying access to the prereading material and one group that, during the exercise, answered its discussion questions by calling the administrator at the local medical center for real-time information.
The hurricane disasters of 2005 and the threat of pandemic infectious diseases compel medical educators to develop emergency preparedness training for medical students and other health care professional students.The objectives of the exercise:1. The students will gain information about the major concepts of disease reporting, the Incident Command System, and risk communication in an All Hazards approach.2. The participants will practice acting in the role of one stakeholder in a involving a disease epidemic (to gain insight into issues that responders from other professional groups must manage).3. Through interaction with others, the participants will understand the roles of various stakeholders in a disease epidemic.4. The participants will increase in attitudes of willingness to cooperate with other stakeholders to accomplish common goals in a time of hazard.
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