Trickle-down’ seminar aims for fellows at top
Pulmonary and ID fellows in Boston, that is
To effect the most change possible, sometimes it makes sense to head straight for the top. That’s the point of a daylong intensive seminar on TB education designed to target pulmonary and infectious disease fellows at teaching hospitals all over the metro Boston area.
"In a teaching hospital, there’s a hierarchy," says Ed Nardell, MD, medical director of the Massachusetts TB control program. On top of the hierarchy are the fellows — the physicians who’ve finished their internships and residencies and been accepted for fellowships in a subspecialty.
"They’re the ones who set the tone, who do the consults, and who say what can be done," says Nardell. "They’re the key people to get at. If we can get a message to the fellows, we can be reasonably sure some of it will trickle down to the residents and medical students who are training in that hospital."
ID fellows are included along with pulmonary for a reason. "TB used to belong exclusively to the pulmonary fellows, but with the coming of HIV, clearly it’s not just their bag anymore," he says.
The crash course Nardell designed, along with the help of his colleague, Boston TB controller John Bernardo, MD, consists of an eight-hour day crammed with practical and academic information.
There are lectures by nine TB experts, including Nardell, Bernardo, and other key people in the state and local TB programs as well as the state lab; talks by public health nurses on practical issues such as case reporting and discharge planning; and an appearance by a TB expert from whichever hospital is hosting the event.
The lasting power of an all-day seminar is substantial, Nardell reasons. "A noontime conference is just something in the breeze — it’s here and then it’s gone." By offering the intensive course two years in a row at all the teaching hospitals in the Boston area, virtually everyone should wind up coming at some point, he adds.
Because physicians trained in Boston wind up in every corner of the country, it makes sense to think the one-day seminars will have a wide spread impact, Nardell says. Closer to home, they’ve already helped strengthen ties between TB controllers and the rest of the medical community, he says.
Not enough experience with TB
Ironically, the idea grew out of what Nardell politely calls "a mess-up" involving none other than a pulmonary fellow. A TB patient was released from one of the city’s teaching hospitals on the wrong drugs, at the wrong doses, and without any discharge planning — all under the purview of the very person who should have known better, the hospital’s pulmonary fellow.
Embarrassed hospital officials offered their thoughts on why such a thing had happened: "Our fellows see so little TB, they don’t have a chance to become proficient in dealing with it," Nardell explains. The solution, as they saw it, was for Nardell to design a three-day TB spectacular along the lines of the one offered by National Jewish Hospital in Denver and present it at every hospital in town.
That didn’t strike Nardell as feasible. A one-day seminar, on the other hand, did.
The seminars are offered free of charge, with host facilities asked to provide a room, lunch, and parking. (Nardell even hauls in his own slide projector.) The slides are designed to fit nicely onto a six-per-page format and eventually will be posted along with other material from the seminar on a Web site, where fellows who’ve attended the seminars can download the material and use it as a teaching tool themselves.
Funding for the TB seminars comes from a TB Academic Award, which both Nardell and Bernardo have received. An honor bestowed by the Heart, Lung, and Blood Institute of the National Institutes of Health, the TB Academic Awards were designed at the peak of the TB epidemic in the early 1990s as a way to improve TB awareness in medical schools and among health care providers.
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