Internal medicine residents' knowledge and practice of pulmonary tuberculosis diagnosis

Natasha Chida, Christopher Brown, Jyoti Mathad, Kelly Carpenter, George Nelson, Marcos C. Schechter, Natalie Giles, Paulina A. Rebolledo, Susan Ray, Valeria Fabre, Diana Silva Cantillo, Sarah Longworth, Valerianna Amorosa, Christian Petrauskis, Catherine V Boulanger, Natalie Cain, Amita Gupta, Jane McKenzie-White, Robert Bollinger, Michael T. Melia

Research output: Contribution to journalArticle

Abstract

Background. Internal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents' ability to diagnose tuberculosis is important. Methods. Internal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service. Our primary outcomes were the mean score and percentage of correct responses per assessment tool question, and the percentage of patients who had Centers for Disease Control and Prevention-recommended tuberculosis diagnostic tests obtained. Results. Of the 886 residents who received the assessment, 541 responded, yielding a response rate of 61%. The mean score on the assessment tool (SD) was 4.4 (1.6), and the correct response rate was 57% (311/541) or less on 9 of 10 questions. On chart review, each recommended test was obtained for ≤ 43% (148/343) of patients, other than chest x-ray (328/343; 96%). A nucleic acid amplification test was obtained for 18% (62/343) of patients, whereas 24% (83/343) had only 1 respiratory sample obtained. Twenty patients were diagnosed with tuberculosis. Conclusions. Significant knowledge and practice gaps exist in internal medicine residents' abilities to diagnose tuberculosis. As residents represent the future providers who will be evaluating patients with possible tuberculosis, such deficiencies must be addressed.

Original languageEnglish (US)
Article numberofy152
JournalOpen Forum Infectious Diseases
Volume5
Issue number7
DOIs
StatePublished - Jul 1 2018

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Internal Medicine
Pulmonary Tuberculosis
Tuberculosis
Nucleic Acid Amplification Techniques
Centers for Disease Control and Prevention (U.S.)
Routine Diagnostic Tests
Communicable Diseases
Thorax
Public Health
X-Rays
Physicians

Keywords

  • Diagnosis
  • Medical education
  • Resident
  • Tuberculosis

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology

Cite this

Chida, N., Brown, C., Mathad, J., Carpenter, K., Nelson, G., Schechter, M. C., ... Melia, M. T. (2018). Internal medicine residents' knowledge and practice of pulmonary tuberculosis diagnosis. Open Forum Infectious Diseases, 5(7), [ofy152]. https://doi.org/10.1093/ofid/ofy152

Internal medicine residents' knowledge and practice of pulmonary tuberculosis diagnosis. / Chida, Natasha; Brown, Christopher; Mathad, Jyoti; Carpenter, Kelly; Nelson, George; Schechter, Marcos C.; Giles, Natalie; Rebolledo, Paulina A.; Ray, Susan; Fabre, Valeria; Cantillo, Diana Silva; Longworth, Sarah; Amorosa, Valerianna; Petrauskis, Christian; Boulanger, Catherine V; Cain, Natalie; Gupta, Amita; McKenzie-White, Jane; Bollinger, Robert; Melia, Michael T.

In: Open Forum Infectious Diseases, Vol. 5, No. 7, ofy152, 01.07.2018.

Research output: Contribution to journalArticle

Chida, N, Brown, C, Mathad, J, Carpenter, K, Nelson, G, Schechter, MC, Giles, N, Rebolledo, PA, Ray, S, Fabre, V, Cantillo, DS, Longworth, S, Amorosa, V, Petrauskis, C, Boulanger, CV, Cain, N, Gupta, A, McKenzie-White, J, Bollinger, R & Melia, MT 2018, 'Internal medicine residents' knowledge and practice of pulmonary tuberculosis diagnosis', Open Forum Infectious Diseases, vol. 5, no. 7, ofy152. https://doi.org/10.1093/ofid/ofy152
Chida, Natasha ; Brown, Christopher ; Mathad, Jyoti ; Carpenter, Kelly ; Nelson, George ; Schechter, Marcos C. ; Giles, Natalie ; Rebolledo, Paulina A. ; Ray, Susan ; Fabre, Valeria ; Cantillo, Diana Silva ; Longworth, Sarah ; Amorosa, Valerianna ; Petrauskis, Christian ; Boulanger, Catherine V ; Cain, Natalie ; Gupta, Amita ; McKenzie-White, Jane ; Bollinger, Robert ; Melia, Michael T. / Internal medicine residents' knowledge and practice of pulmonary tuberculosis diagnosis. In: Open Forum Infectious Diseases. 2018 ; Vol. 5, No. 7.
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abstract = "Background. Internal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents' ability to diagnose tuberculosis is important. Methods. Internal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service. Our primary outcomes were the mean score and percentage of correct responses per assessment tool question, and the percentage of patients who had Centers for Disease Control and Prevention-recommended tuberculosis diagnostic tests obtained. Results. Of the 886 residents who received the assessment, 541 responded, yielding a response rate of 61{\%}. The mean score on the assessment tool (SD) was 4.4 (1.6), and the correct response rate was 57{\%} (311/541) or less on 9 of 10 questions. On chart review, each recommended test was obtained for ≤ 43{\%} (148/343) of patients, other than chest x-ray (328/343; 96{\%}). A nucleic acid amplification test was obtained for 18{\%} (62/343) of patients, whereas 24{\%} (83/343) had only 1 respiratory sample obtained. Twenty patients were diagnosed with tuberculosis. Conclusions. Significant knowledge and practice gaps exist in internal medicine residents' abilities to diagnose tuberculosis. As residents represent the future providers who will be evaluating patients with possible tuberculosis, such deficiencies must be addressed.",
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AU - Chida, Natasha

AU - Brown, Christopher

AU - Mathad, Jyoti

AU - Carpenter, Kelly

AU - Nelson, George

AU - Schechter, Marcos C.

AU - Giles, Natalie

AU - Rebolledo, Paulina A.

AU - Ray, Susan

AU - Fabre, Valeria

AU - Cantillo, Diana Silva

AU - Longworth, Sarah

AU - Amorosa, Valerianna

AU - Petrauskis, Christian

AU - Boulanger, Catherine V

AU - Cain, Natalie

AU - Gupta, Amita

AU - McKenzie-White, Jane

AU - Bollinger, Robert

AU - Melia, Michael T.

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N2 - Background. Internal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents' ability to diagnose tuberculosis is important. Methods. Internal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service. Our primary outcomes were the mean score and percentage of correct responses per assessment tool question, and the percentage of patients who had Centers for Disease Control and Prevention-recommended tuberculosis diagnostic tests obtained. Results. Of the 886 residents who received the assessment, 541 responded, yielding a response rate of 61%. The mean score on the assessment tool (SD) was 4.4 (1.6), and the correct response rate was 57% (311/541) or less on 9 of 10 questions. On chart review, each recommended test was obtained for ≤ 43% (148/343) of patients, other than chest x-ray (328/343; 96%). A nucleic acid amplification test was obtained for 18% (62/343) of patients, whereas 24% (83/343) had only 1 respiratory sample obtained. Twenty patients were diagnosed with tuberculosis. Conclusions. Significant knowledge and practice gaps exist in internal medicine residents' abilities to diagnose tuberculosis. As residents represent the future providers who will be evaluating patients with possible tuberculosis, such deficiencies must be addressed.

AB - Background. Internal medicine physicians are often the first providers to encounter patients with a new diagnosis of tuberculosis. Given the public health risks of missed tuberculosis cases, assessing internal medicine residents' ability to diagnose tuberculosis is important. Methods. Internal medicine resident knowledge and practice patterns in pulmonary tuberculosis diagnosis at 7 academic hospitals were assessed utilizing (a) a 10-item validated pulmonary tuberculosis diagnosis assessment tool and (b) a retrospective chart review of 343 patients who underwent a pulmonary tuberculosis evaluation while admitted to a resident-staffed internal medicine or infectious disease service. Our primary outcomes were the mean score and percentage of correct responses per assessment tool question, and the percentage of patients who had Centers for Disease Control and Prevention-recommended tuberculosis diagnostic tests obtained. Results. Of the 886 residents who received the assessment, 541 responded, yielding a response rate of 61%. The mean score on the assessment tool (SD) was 4.4 (1.6), and the correct response rate was 57% (311/541) or less on 9 of 10 questions. On chart review, each recommended test was obtained for ≤ 43% (148/343) of patients, other than chest x-ray (328/343; 96%). A nucleic acid amplification test was obtained for 18% (62/343) of patients, whereas 24% (83/343) had only 1 respiratory sample obtained. Twenty patients were diagnosed with tuberculosis. Conclusions. Significant knowledge and practice gaps exist in internal medicine residents' abilities to diagnose tuberculosis. As residents represent the future providers who will be evaluating patients with possible tuberculosis, such deficiencies must be addressed.

KW - Diagnosis

KW - Medical education

KW - Resident

KW - Tuberculosis

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