Resident Physician Case Study

Resident physicians are usually the first to see patients in most teaching institutions, and should protect themselves against infectious agents. Their knowledge of infectious agents and disease process is critical. Knowledge of EVD is not only important to residents, but to the general public as a whole. Although the 2014 West African Ebola epidemic was prevalent in the news, only 6.7% of the residents identified all of the early symptoms of EVD. Residents exhibited poor knowledge of good hygiene practices, with 58.3% believing washing hands with water or non alcohol based sanitizer is a good hygiene practice. Knowledge of any disease or condition is important. Slightly more than half (55%) of the residents recognized isolation as the first step in the management of EVD and only 16.7% answered correctly on whether PPE was required for individuals driving or riding in a car carrying human remains of EVD deceased patient. The results suggested that recent graduates from medical school did better on knowledge of average symptoms time of EVD
and length of time to monitor health after returning from an EVD infected area. Occupational medicine and preventive medicine residents did better on the knowledge of first step of management of EVD, and on handling of human remains of deceased EVD patients respectively. Younger residents did better on knowledge of avoiding EVD treatment centers.
There was no difference in knowledge of EVD with regards to EVD and the type of medical school (International medical graduates vs U.S/Canadian graduates). There was no significant difference in post graduate year levels knowledge of EVD. No known study have addressed knowledge of EVD among resident physicians in the U.S, which limits comparison with an existing study. Recent and younger graduates had significantly better knowledge of EVD. Recent graduates are likely to be more current on evolving diseases of epidemic. They are up to date with new treatments and are likely to apply them. A systematic review evaluating the relationship between clinical experience and quality of health care showed that in terms of current standards of care and of clinical developments, younger physicians were more up to date.
7 There was no significant finding between residents who graduated from medical school outside the U.S with those that graduated in the U.S/Canada. Some might have speculated that international medical graduates would more likely be more knowledgeable about EVD than U.S/Canadian graduates. We found no significant difference between these two groups of graduates. This was expected finding since the 2014 West African Ebola epidemic was limited to West Africa and previous outbreaks have been limited to Central Africa. Just like American/ Canadian graduates, most likely majority of the international medical graduates have not been exposed to and have not manage an EVD patient. Therefore, no difference in knowledge was expected. Occupational medicine and preventive medicine residents did better on the knowledge of first step of management of EVD, and on handling of human remains of deceased EVD patients respectively. At Meharry medical college, the occupational and preventive medicine residents do attend weekly didactics together. Residents are taught preventive measures and global health topics that are included in the American Board of Preventive Medicine certification exams. So, it was not surprising when they performed significantly better than other specialties in this aspect. However, what was surprising was the fact that they did not perform better on all the other questions posed. EVD is a public health problem. This Epidemic is ongoing and will most likely not be the last EVD epidemic in the world. It is prudent therefore for physicians to be knowledgeable about EVD and emerging diseases that have the potential to overwhelm our public health systems. The sample size of this study was small, which might limit generalizability. Also, since it was performed in a single institution, generalizability is limited. These findings may not actually reflect the knowledge of the residents because of their busy schedule or possible lack of interest. These results should be an impetus for further research in the knowledge of EVD and emerging diseases that are of public health concern. Intervention programs such as lecture series might improve the knowledge base of residents.