VHA Clinicians and Bioterror Events: Interactive Web-based Learning
Catarina I. Kiefe PhD MD
Brimingham VA Medical Center
Birmingham, AL
Funding Period: October 2002 - September 2007

BACKGROUND/RATIONALE:
Because of VA’s long history in disaster preparedness, and the crucial role VA providers will play, the VA medical system has the potential to make an enormous difference in outcomes following a bioterror attack or infectious outbreak. A 2002 AHRQ report reviewed 60 studies and found that very few bioterrorism preparedness training programs were rigorously evaluated. Our project was the first effort to formally test and implement a bioterrorism preparedness intervention in the VA healthcare system. Because Internet-delivered interventions have the potential for wide dissemination, we used the Internet to implement the Intervention.

OBJECTIVE(S):
1. To develop, tailor, and continuously update and validate evidence- and scenario-based electronic teaching and testing modules to increase VA clinicians’ knowledge of Category A biological warfare agents. We refer to these instruments as Bioterrorism Case Analysis and Skills Enhancement Sessions (BioCASES) and Bioterrorism Skills Test Sessions (BioTESTS).
2. To test the effectiveness of the BioCASES teaching modules by way of a randomized controlled trial of VAMCs using the BioTESTS to evaluate their effectiveness for increasing and sustaining VA clinician knowledge, skills, and ability to respond to bioterrorism events.
3. To continue to develop and adapt BioCASES and BioTESTS for use in VA CME programs. Ultimately, we will disseminate the intervention throughout the entire VA system.

METHODS:
Our project team developed or refined and updated a total of 12 educational modules focusing on CDC’s Category A agents and other emerging infectious diseases. We developed post-test instruments and case-based scenarios germane to the VA patient population for anthrax and smallpox. Materials were designed specifically for the unique clinician populations and electronic educational applications available in VAMCs. Website functionality and content were refined using the nominal group technique and “thinking aloud” protocols. We tested our innovative, web-based educational intervention at fifteen VA facilities via a randomized controlled trial (RCT).

FINDINGS/RESULTS:
The study had 332 participants (155 BioCASES; 177 CDC control). Of those, 58% (n=192) completed the immediate BioTESTs. Participants were MDs/DOs (81%) or NPs/PAs (19%), with 51% male, and a median of 17 years in practice. We noted higher anthrax, but not smallpox, provider knowledge on immediate and delayed posttest for those using BioCASES compared with our robust control, the CDC website bioterror content. This intervention effect holds after adjustment for clustering and other provider characteristics. These findings indicate that our intervention, the BioCASES modules, is an effective instructional approach.

IMPACT:
We expect that our content and methods will enable us to impart actionable knowledge about bioagents to VA physicians. Our study will test this expectation via an inter-VISN group- randomized controlled trial of net-based modules currently developed for anthrax and smallpox, the first ever performed on these instruments. The results of this study will be particularly useful to the VA health system for several reasons; in particular VA patients are more likely to present with confounding illnesses and VA physicians will need specialized, sustainable skills to treat them after a biological attack. Moreover, learning tools for other rare or emerging infections, such as SARS, can be derived from those tested, thus making them truly dual-use.

PUBLICATIONS:

Journal Articles

1. Terndrup T, Nafziger S, Weissman N, Casebeer L, Pryor E. Online bioterrorism continuing medical education: development and preliminary testing. Academic Emergency Medicine. 2005; 12(1): 45-50.
2. Abdolrasulnia M, Strasser S, Pryor E, Terndrup T, Weissman NW, Williams M, Heck E, Casebeer L. Spatial Patterns Representing the Geographic Impact of Physician Participation in an Online CME Bioterrorism Course Following the Anthrax Events of 2001. Medinfo. 2004; 2004(CD): 1498.
3. Bennett NL, Casebeer LL, Kristofco RE, Strasser SM. Physicians' Internet information-seeking behaviors. The Journal of Continuing Education in The Health Professions. 2004; 24(1): 31-8.
4. Filoromo C, Macrina D, Pryor E, Terndrup T, McNutt SD. An innovative approach to training hospital-based clinicians for bioterrorist attacks. American Journal of Infection Control. 2003; 31(8): 511-4.
5. Casebeer LL, Strasser SM, Spettell CM, Wall TC, Weissman N, Ray MN, Allison JJ. Designing tailored Web-based instruction to improve practicing physicians' preventive practices. Journal of Medical Internet Research [Electronic Resource]. 2003; 5(3): e20.
6. O'Byrne WT, Terndrup TE, Kiefe CI, Weissman NW. A Primer on Biological Weapons for the Clinician, Part II. Advanced Studies in Medicine. 2003; 3: 157-167.
7. O'Byrne WT, Terndrup TE, Kiefe CI, Weissman NW. A Primer on Biological Weapons for the Clinician, Part I. Advanced Studies in Medicine. 2003; 3: 75-86.

DRA: Health Services and Systems, Military and Environmental Exposures
DRE: Communication and Decision Making
Keywords: Education (provider)
MeSH Terms: Emergency Medical Services, Health Education, Physician Practice Patterns