Workshop Materials Booklet

Competencies to Curriculum in the Context of Preparedness
Friday, September 22, 2006

Research Park Center
10000 Innovation Drive

Facilitators:
Kristine Gebbie, DrPH, RN
William W. Greaves, MD, MSPH
Nancy Healy-Haney, PsyD, MPH, RN
J ason Liu, MD
Donna Page, MPH

2
Table of Contents
I. About this Workshop .. 3

II. Agenda 4

III. Clinician Competencies.. 5

IV. Slides. 7

V. Group Activity .. 38

VI. Competencies to Curriculum Examples. 42
Example 1.1 Medicine
Example 1.2 Nursing
Example 1.3 Dentistry

VII. Incorporating Competencies and Content into Existing Course Curricula 58
Example 2.1 Medicine
Example 2.2 Nursing
Example 2.3 Dentistry

VIII. Sample Syllabi. 67
Syllabus 1.1 Medicine
Syllabus 1.2 Nursing
Syllabus 1.3 Dentistry

IX. Resources 87
Columbia University Common Competencies in Emergency Preparedness for the Health Sciences
Sample Lesson Plan Format
Bibliography
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I. ABOUT THIS WORKSHOP

Target audience: Persons with responsibility for, or interest in, finding ways to enhance community emergency
response capacity through development and implementation of innovative training programs and materials.

Goal: The goal of this workshop is to share ways in which emergency preparedness competency training can
be included in curricula and training programs for health and public health professionals. Materials are based
on Columbia Universitys experience in developing emergency preparedness competencies and training
programs in health departments, hospitals and health professional schools. The Competencies to Curriculum
Toolkit provides the framework for the workshop.
(http://www.cumc.columbia.edu/dept/nursing/research/ResCenters/chphsr/pdf/toolkit.pdf)

Principal learning objective: Participants will be able to incorporate emergency preparedness principles and
content into curricula through the use of the Competency-to-Curriculum Toolkit and Clinician Competencies for
Emergency Preparedness.

Learning activities: Presentation, small group exercises, discussion. Competency-based examples of
integrated presentation using the format from the Competency-to-Curriculum Toolkit for presentations,
handouts, slides and resources will be provided during this workshop.

Workshop Partners: Medical College of Wisconsin, Association for Prevention, Teaching, and Research
(APTR), and Center for Health Policy Columbia University School of Nursing,
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II. WORKSHOP AGENDA

9:30a.m. Sign in, Coffee

10:00 a.m. Detailed presentation on walking from BT competencies to
course curriculum and innovative teaching methods

11:00 a.m. Small group exercise for developing courses and training
modules for selected topics and audiences

12:00 p.m. Lunch break (lunch provided)

12:30 p.m. Small group exercises resumes

1:00 p.m. Putting it all together

3:00 p.m. Adjourn

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CL|N|C|AN
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Competency DeveIopment
These competencies were developed by the Association oI
Teachers oI Preventive Medicine in collaboration with the
Center Ior Health Policy, Columbia University School oI
Nursing. The authors would like to extend their sincere
appreciation to the Centers Ior Disease Control and
Prevention, OIIice oI Terrorism Preparedness and Emergency
Response and to the many individuals and national
proIessional associations that generously gave oI their
expertise and guidance during the development oI these
competencies to ensure their relevance to the needs oI
Iront-line clinicians. The list oI organizations that participated
in draIting the competencies Iollows and does not refect
approval or oIIicial position.
American Academy oI Dermatology
American Academy oI Family Physicians
American Academy oI Nurse Practitioners
American Academy oI Pediatrics
American College oI Emergency Physicians
American College oI Obstetricians and Gynecologists
American College oI Physicians
American Medical Association
American Osteopathic Association
Association oI Community Health Nursing Educators
Association oI Schools oI Public Health
Association oI State and Territorial Health OIIicials
Association oI Teachers oI Preventive Medicine
Centers Ior Disease Control and Prevention
Council oI State and Territorial Epidemiologists
National Association oI County and City Health OIIicials
This document incorporates comments made through review
oI the competencies by over 1,400 individual physicians,
nurses, emergency medical technicians, mental health
proIessionals, emergency response experts and others; the
majority oI whom were identifed as very knowledgeable in
emergency response.
For Iurther inIormation about these competencies, or Ior
additional copies oI this document, contact:
Center Ior Health Policy
Columbia University School oI Nursing
630 West 168th Street, Mail code 6
New York, New York 10032
kmg24columbia.edu
This project was made possible through a Cooperative Agreement between
the Centers Ior Disease Control and Prevention and the Association oI
Teachers oI Preventive Medicine, award number U50/CCU300860; its
contents are the responsibility oI the authors and do not necessarily refect the
oIIicial views oI CDC or ATPM.
Background
A priority Ior public health agencies, proIessional
associations and other involved organizations is that
clinicians know about inIectious organisms or
chemicals that might be involved in a disaster or
terrorist event and to ensure that they have the
competency to apply that knowledge. A
well-deIined, practiced disaster plan; a competent
workIorce that is available and willing to respond;
and appropriate technological inIrastructure are
essential to any health-related organization in order
Ior a community to respond to a wide-scale
emergencydeliberately caused or not.
Clinicians are key to early detection oI many
adverse events, crucial to rapid decision-making
about clinical management, and vital to appropriate
reporting to
public health
oIIicials. Any
clinician in a
position to
make initial
assessment s
and decisions
needs the
competencies
in emergency preparedness. II that clinician has
Iurther responsibilities, such as inIectious disease
management, mental health services, or nursing
care, additional knowledge and competencies
speciIic to the proIession and condition will be
applied.
Many clinicians already have acquired some oI the
identiIied competencies. In other cases, a substantial
level oI additional knowledge and competency-based
education is needed to achieve the desired level oI
readiness. The competencies identiIied through this
project will be used to develop training and to assess
the preparedness oI clinicians
COLUMBIA UNIVERSITY
Schoo| of Nurslng
A''C\IA1IC CI 1IA\III'
CI IIIVI1IVI ^III\II
Whether you practice in an emergency department, hospital clinic, urgent care center,
medical office, patient telephone triage line, or elsewhere, you may become part of your
community's emergency response system. These clinical competencies describe the abilities
that you should possess to recognize new problems, effectively communicate with patients and
report to administrators, and obtain needed guidance during emergency response situations.
While the competencies are generic to clinical practice, they are always defined or limited by the
legal scope of practice of the specific professional discipline.
ARE YOU A CLINICIAN WHO SEES AND TRIAGES PATIENTS?
DO YOU COMMUNICATE WITH PATIENTS?
Then you are in the position to recognize initial cases and manage the
initial care and referral of patients in an emergency event.
A CLINICIAN IN AN INITIAL ASSESSMENT AND DECISION-MAKING ROLE SHOULD BE ABLE TO:
ASSCCIAJIC CI JACIIS
CI IIVJIV MIICI
Describe your expected role in emergency
response in the specifc practice setting as a part oI
the institution or community response.
Respond to an emergency event within the
incident or emergency management system oI the
practice, institution and community.
Recognize an illness or injury as potentially
resulting Irom exposure to a biologic, chemical or
radiologic agent possibly associated with a
terrorist event.
Recognize uncommon presentations oI
common diseases and distinguish these Irom
common presentations oI uncommon
diseases that may be related to a terrorist
event or emerging inIectious disease.
Recognize emerging patterns or clusters oI
unusual presentations.
Institute appropriate steps to limit spread,
including inIection control measures,
decontamination techniques and use oI
appropriate personal protective equipment.

Report identifed cases or events to the public
health system to Iacilitate surveillance and
investigation using the established institutional or
local communication protocol.
Initiate patient care within your proIessional scope
oI practice and arrange Ior prompt reIerral
appropriate to the identifed condition(s).
Use reliable inIormation sources (e.g., inIection
control department, state or local public health
agency, Centers Ior Disease Control and
Prevention) Ior current reIerral and management
guidelines.
Provide reliable inIormation to others (e.g.,
institutional administration, other patients) as
relevant to the specifc practice site and emergency
response protocol.
Communicate risks and actions taken clearly and
accurately to patients and concerned others.
IdentiIy and manage the expected stress/anxiety
associated with emergency events, making
reIerrals Ior mental health services iI needed.
Participate in post-event Ieedback and assessment
oI response with the local public health system and
take needed steps to improve Iuture response.
1. 4.
3.
2.
a.
b.
10.
9.
8.
7.
6.
5.
11.
COLUMBIA UNIVERSITY
Schoo| of Nurslng
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IV. SLIDES
Slide 1

Teaching Emergency
Preparedness
From Competencies to Curriculum
Association for Prevention Teaching and Research
And
Center for Health Policy
Columbia University School of Nursing
September 22, 2006

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Slide 2
Sept. 22, 2006
Goals for this workshop
Review the relationship of competencies and
curriculum
Review the core emergency preparedness
competencies for clinicians
Discuss the steps in moving from any
competency set to a curriculum
Practice the process of planning an
educational experience that includes an
emergency exercise as a learning opportunity

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Slide 3
Sept. 22, 2006
A well-built curriculum
Does not have to be complex
Is worth thinking through before
presentation
Is definitely more than a one-time
content presentation
Can make the difference in having a
well-prepared workforce!

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Slide 4
Sept. 22, 2006
Competency
an individual measure of applied skills and
knowledge that enable people to perform
work.
consists of
action verb (observable or measurable
performance of a worker)
content (subject matter, type of performance,
specific task)
context (limitations or conditions of work
environment).

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Slide 5
Sept. 22, 2006
Plenty of emergency
preparedness competencies
Public health workers
Hospital workers
Clinicians
Nurses (INCMCE)
Basic and advanced disaster Life
support (AMA)

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Slide 6
Sept. 22, 2006
These vary on several
dimensions
Focus on education or workplace
Focus on level of attainment
Focus on various workers

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Slide 7
Sept. 22, 2006
Education or the workplace?
Workplace statements
complex performance within the workplace, akin
to KSAs of job classifications.
a series of embedded tasks that are either
sequential or parallel.
demonstrated over long periods of time.
require contextual measurement.
allow for a range of indicators to measure
competence.

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Slide 8
Sept. 22, 2006
Example of a workplace
competency
A clinician is able to respond to an
emergency event within the emergency
management system of his/her practice,
institution and community.

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Slide 9
Sept. 22, 2006
Education or the workplace?
Instructional Competencies
the building blocks of learning experiences.
structured learning activities.
require higher levels of performance to be
built upon lower level ones.
determine the measurement indicators.
require measurement in the short term.

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Slide 10
Sept. 22, 2006
Example of an instructional
competency
The medical student will be able to
conduct a physical exam that is guided
by information about exposure or
potential exposure to CBRNE

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Slide 11
Sept. 22, 2006
Levels? Or different
competencies?
Aware: Basic level of mastery of the
competency. Individuals may be able to
identify the concept or skill but have limited
ability to perform the skill.
Knowledgeable: Intermediate level of
mastery of the competency. Individuals are
able to apply and describe the skill.
Proficient: Advanced level of mastery of the
competency. Individuals are able to
synthesize, critique or teach the skill.

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Slide 12
Sept. 22, 2006
Level of worker expertise
Novice: new to a skill or attribute
entry-level
seasoned professional with limited exposure to the
area.
Intermediate: detailed knowledge in area
Often mid-level and has supervisory
responsibilities.
Expert: mastery of a skill
Often this person the highest ranking person in
the skill area.

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Slide 13
Sept. 22, 2006
How do competencies fit in?
Workforce
competencies
Instructional
Competencies
&Curriculum
Organizational
performance
Individual worker
performance
Intervening
variables

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Slide 14
Sept. 22, 2006
Blooms Taxonomy
KNOWLEDGE
COMPREHENSION
APPLICATION
ANALYSIS
SYNTHESIS
EVALUATION
Increasing
independence

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Slide 15
Sept. 22, 2006
Sample Skills by Blooms
Taxonomy
Knowledge: name, list, arrange, relate, specify,
enumerate, define, recall, label, cite, repeat,
copy, order, record
Comprehension: describe, iterate, recognize,
summarize, explain, discuss, locate, input,
translate, paraphrase, itemize
Application: practice, calculate, compute, sketch,
illustrate, interview, operate, simulate,
demonstrate, apply, schedule, utilize, relate,
diversify

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Slide 16
Sept. 22, 2006
Sample Skills by Blooms
Taxonomy
Analysis: interpret, test, differentiate, scrutinize,
investigate, interpret, compare, contrast,
discriminate, distinguish, question, manipulate,
dissect, estimate, measure
Synthesis: compose, construct, predict, reason,
hypothesize, design, formulate, manage, develop,
assemble, propose, theorize, invent, attribute,
simplify
Evaluation: judge, assess, recommend, determine,
criticize, argue, defend, estimate, appraise, justify,
feedback, review

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Slide 17
Sept. 22, 2006
The clinician competencies
Licensed healthcare providers (e.g., MD, DO,
DDS, RN, Advanced Practice Nurse, Physician
Assistant, Clinical Psychologist, Clinical Social
Worker, Optometrist) who see and triage
patients or communicate with patients and
are in a position to recognize initial cases and
manage the initial care and referral of
patients.
In all cases, the competencies are understood
to be defined or limited by the legal scope of
practice of the specific clinician.

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Slide 18
Sept. 22, 2006
The clinician in an initial assessment
and decision-making role is able to
describe his/her expected role in
emergency response in the specific
practice setting as a part of the
institution or community response.
respond to an emergency event within
the emergency management system of
his/her practice, institution and
community.

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Slide 19
Sept. 22, 2006
and
recognize an illness or injury as potentially
resulting from exposure to a biologic,
chemical or radiologic agent possibly
associated with a terrorist event.
recognize uncommon presentations of common
diseases and distinguish these from common
presentations of uncommon diseases that may be
related to a terrorist event or emerging infectious
disease.
recognize emerging patterns or clusters of unusual
presentations

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Slide 20
Sept. 22, 2006
and
institute appropriate steps to limit spread,
including infection control measures,
decontamination techniques and use of
appropriate personal protective equipment.
report identified cases or events to the public
health system to facilitate surveillance and
investigation using the established institutional
or local communication protocol.
initiate patient care within your professional
scope of practice and arrange for prompt
referral appropriate to the identified
condition(s).

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Slide 21
Sept. 22, 2006
and
use reliable information sources for current
referral and management guidelines.
provide reliable information to others (e.g.,
institutional administration, other patients) as
relevant to the specific practice site and
emergency response protocol.
communicate risks and actions taken clearly
and accurately to patients and concerned
others.

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Slide 22
Sept. 22, 2006
and finally
identify and manage the expected
stress/anxiety associated with emergency
events, making referrals for mental health
services if needed.
participate in post-event feedback and
assessment of response with the local public
health system and take needed steps to
improve future response.

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Slide 23
Sept. 22, 2006
Steps to a curriculum
Select competency(ies)
Define key words or
phrases within the
competency
Describe the target
audience
Sequentially separate all
required sub-
competencies
Develop objectives for
each sub-competency
Relate an evaluation
procedure to learning
objectives
Provide relevant content
(theory and practice)
for each sub-
competency
Plan specific learning
experiences for all
identified objectives

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Slide 24
Sept. 22, 2006
Example: Emergency
Preparedness Continuing Ed
Assumption: you have been asked to
plan a program for the staff of a local
community clinic
Goal: assure that all of the clinical staff
are prepared to follow the community
emergency plan in which the clinic
becomes a site for minor triage and
supportive care.

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Slide 25
Sept. 22, 2006
Step 1. Competency selected
This may be based on organizational or
individual needs assessment
Your contact person has said that a key problem is
adherence to emergency chain of command
Selection from the emergency preparedness
competencies for clinicians
respond to an emergency event within the
emergency management system of his/her
practice, institution and community.

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Slide 26
Sept. 22, 2006
Step 2. Definition of key terms
Emergency management system:
The Incident Command System (ICS)
linking clinics to the health sector within
the unified command structure of the
county, consistent with the principles of
the National Incident Management System
(NIMS).

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Slide 27
Sept. 22, 2006
Step 3. Define target
audience:
All clinical staff of the community clinic,
including MD, PA, NP, DDS, RN.
Some of these individuals work part-
time, and several are new to the
practice
Additional needs assessment may be
conducted

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Slide 28
Sept. 22, 2006
Step 4. Separate the sub-
competencies
Describe the principles of ICS
Describe the XYZ county emergency
management system
Discuss the chain of command that links the
clinic to the health sector in the ICS plan
Identify the chain of command that will exist
within the clinic during an emergency
Follow the chain of command during an
exercise or real emergency

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Slide 29
Sept. 22, 2006
Step 5. Develop learning
objectives 1:
Describe the principles of ICS
Predictable chain of command
Modular organization, flexible organization
chart
Accountability and clearly defined roles
Common terminology
Use of action plans with a defined
operational period

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Slide 30
Sept. 22, 2006
Learning objectives 2
Describe the XYZ county emergency
management system
Modify standard ICS chart to be consistent
with XYZ county
Fill in names of all key agency players

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Slide 31
Sept. 22, 2006
Discuss the chain of command that links the
clinic to the health sector in the ICS plan
Describe all components of the health sector in
the ICS plan
Health department
Hospitals
Long termcare facilities
Community clinics
Medical Reserve Corps unit
Discuss the activation and functioning of the chain
of command

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Slide 32
Sept. 22, 2006
Identify the chain of command that will exist
within the clinic during an emergency
How is an emergency identified
Who assumes command
What does the individual clinician do
If at work when the emergency begins
If at home when the emergency begins
If he/she has responsibilities within another institution

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Slide 33
Sept. 22, 2006
Step 6: Select evaluation
procedures*
Objective test
Objective self report
Essay
Oral report
Planned observation
Product
Performance
Chosen in this case because of the 4
th
objective
* in order of efficiency

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Slide 34
Sept. 22, 2006
Step 7. Identify relevant key
content
Expert consultation
Publications
Policy and procedure manual for clinic

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Slide 35
Sept. 22, 2006
Step 8. Plan the learning
experiences
Map out a sequence of classroom, self-guided
or experiential learning experiences that can
take the learner to the desired level of
competency.
If there are multiple competencies to learn,
the individual experiences may combine
several
The curriculum may occur in a compressed
period, or be spread over many months.

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Slide 36
Sept. 22, 2006
Plan the learning experiences
A one-hour classroom lecture/discussion can
cover all key content areas identified
The evaluation exercise will require an
additional hour, and may follow the
classroom experience immediately, or at a
later date
Both should be repeated a sufficient number
of times that ALL clinicians can participate

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Slide 37
Sept. 22, 2006
Step 9 Present and evaluate
This is the fun part!!
Make sure that audience is attentive
and engaged.
Make sure any observers are
acquainted with the goals and remain
unobtrusive.

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Slide 38
Sept. 22, 2006
Small group task one:
Assume you are the curriculum or CE
planning committee for an emergency
preparedness learning event that will include
an emergency drill or exercise
Who is your audience?
Profession(s)?
Previous exposure/experience?
What is the setting?
Single workplace?
Professional school?
Other?

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Slide 39
Sept. 22, 2006
Drills and exercises
These are both experiential learning
and an opportunity to evaluate
Once you move beyond workshops,
they are easier to work with as system-
level evaluation rather than individual
assessment

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Slide 40
Sept. 22, 2006

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Slide 41
Sept. 22, 2006
Defining any drill
ORIENTATION
Or SEMINAR
TABLETOP
EXERCISE
FUNCTIONAL
DRILL
FULL
SCALE
DEFINITION
PURPOSE/
OBJ ECTIVES

SETTING
MATERIALS
PARTICIPANTS
CONDUCT
EVALUATION

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Slide 42
Sept. 22, 2006
Exercise investment
Exercises dont just happen
Costs
Time
Advance training
Materials/resources

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Slide 43
Sept. 22, 2006
Planning an exercise
Define the Purpose of the Exercise
Identify Goals & Measurable Objectives
Define the Scope of the Exercise
Define the Scale of the Exercise
Select the Exercise Scenario
Select the Exercise Format
Define the Evaluation Method
Develop the Exercise Work Plan and Schedule

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Slide 44
Sept. 22, 2006
Examples
Design risk communication and
methods to disseminate public
education information on exposure
hazards and effective public response.
Practice clinician behavior associated
with transition into emergency role
assigned by local health agency

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Slide 45
Sept. 22, 2006
Example
Test a POD operational model:
introduce students to POD management
and J ob Action Sheet (J AS) responsibilities.
provide students with an opportunity to
practice ICS & functional staff roles to
expeditiously receive and dispense
appropriate medications.

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Slide 46
Sept. 22, 2006
Draft goal: activate POD clinic
Is the goal realistic?
Has the organization opened a POD before?
Does the organization have the resources and
support to open a POD?
Is the goal achievable?
Is there a time limit on how quickly the POD
needs to be set up?
Is the target number of patient through-put too
high or too low?

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Slide 47
Sept. 22, 2006
Discussion-Based Exercises
Tabletops (TTX)
Purpose is training
A controller orients participants to objectives, ground
rules and communication and simulation procedures.
The scenario describes an event or emergency
incident and brings participants up to a simulated
present time.
May use an imaginary jurisdiction or use participants
knowledge of actual local resources.
The controller sets the pace.

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Slide 48
Sept. 22, 2006
Operation-Based Exercise
Drills
Purpose is to instruct thoroughly by repetition.
Used to test personnel training, response time,
interagency cooperation and resources, manpower
and equipment capabilities.
Staff should have an understanding of the function
being tested and be given an opportunity to ask
questions.
A briefing by the drill designer sets the scene and
reviews its purpose and objectives.
Operational procedures to be tested and safety
precautions are reviewed before the drill begins.

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Slide 49
Sept. 22, 2006
Example of options
Practice clinician behavior associated with transition
into emergency role assigned by local health agency
Tabletop
Vignettes about clinic activity & specific patients
challenging clinicians to change fromusual care to
emergency plan
Scenario requires a clinician to assume command
function
Functional drill
Announce change to emergency plan, manage patients
already in clinic and convert clinic to fit emergency plan
Challenge process by activating some clinicians to roles
elsewhere in community

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Slide 50
Sept. 22, 2006
Using the National Planning
Scenarios
Scenario 1: Nuclear Detonation
Scenario 2: Biological Attack
Aerosol Anthrax
Scenario 3: Biological Disease
Outbreak Pandemic Influenza
Plague
Scenario 5: Chemical Attack
Blister Agent
Toxic Industrial Chemicals
Nerve Agent
Chlorine Tank Explosion
Scenario 9: Natural Disaster
Major Earthquake
Scenario 10: Natural Disaster
Major Hurricane
Scenario 11: Radiological Attack
Radiological Dispersal Devices
Scenario 12: Explosives Attack
Bombing Using Improvised
Explosive Devices
Food Contamination
Foreign Animal Disease (Foot
and Mouth Disease)
Scenario 15: Cyber Attack

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________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

32
Slide 51
Sept. 22, 2006
Small group task two:
Working from the audience and setting
you have identified
Select the competency(ies) that will be the
focus of learning through an exercise
State the specific objective of the exercise
Plan the exercise scenario

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 52
Sept. 22, 2006
Evaluation questions
Did you reach the point you wanted?
Did you reach that point when you
wanted to?
Were all students appropriately
involved?
Were you pleased with the manner in
which you got to the end point?

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

33
Slide 53
Sept. 22, 2006
Be clear on what you are
evaluating, such as
The exercise process
An organizations emergency plan
The ability of the organization to fulfill the
plan
The speed with which some portion of the
plan is put in to place
The efficiency with which some portion of the
plan can be carried out
The competency of individuals in some
specific functional roles

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 54
Sept. 22, 2006
Individual competency in
functional roles
Identify in advance the functional roles
that need to be assessed
Competency statements and applicable
J AS must be incorporated into the
assessment

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

34
Slide 55
Sept. 22, 2006
Ways to evaluate
Hot wash
comments
Narrative of
observations
Subjective
Post-event
checklist
Checklist with
stated
objectives
Objective
Participant External
evaluator

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 56
Sept. 22, 2006
Sample for recording
Exercise Objective Number (1___): Objective: Demonstrateabilitytodevelopand
adapt SectionActionPlanduringanemergency

Anticipated Actions:

Met Not
Met
Not
Observed
1. IdentifyexpectationsfromIAP
2. Prepareinitial SAP for timeframe
3. CommunicateSAP toteammemberswithJ AS
4. DeveloprevisedSAP withnewdataor newIAP
5. CommunicatenewSAP toteammembers

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

35
Slide 57
Sept. 22, 2006
Pre-drill
Identify all functional roles to be activated
Include those functional roles likely to be
identified if initial participants perform as
desired
Example:
Planning unit activated
Planning calls for extensive field epidemiology

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 58
Sept. 22, 2006
Pre-drill
Prepare observer documents
Criteria to be observed
J AS to be observed
Prepared participant feedback form
One form for those carrying out assigned J AS
One form for any individual playing parts of
community members or patients during the
drill.

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

36
Slide 59
Sept. 22, 2006
Small group task 3
Identify all materials you will need for
the exercise you have selected
Outline all components of the
evaluation that will allow you to assess
student learning

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 60
Sept. 22, 2006
Small group summaries
Biggest challenges?
Easiest problems to solve?
What next?

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

37
Slide 61
Sept. 22, 2006
Thank you for your participation!

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
Slide 62
Sept. 22, 2006
http://www.nursing.hs.columbia.edu
Association for
Prevention
Teaching and
Research

________________________________
________________________________
________________________________
________________________________
________________________________
________________________________
________________________________

SECTION TAB

PLACEHOLDER

38
V. Group Activity: Worksheet
Steps to Competencies Curriculum
(Intentionally left blank - may also be used as a Template)

The competency selected for the example is from the emergency preparedness competencies for:

In this example, the key term is:

Step 3. Define target audience:
The target audience for this training will include:

Step 4. Separate the sub-competencies.
If these students are to be able to (list competency here) hen they must be able to:
list
list
list
list

39
V. Group Activity: Worksheet, cont.

Step 5. Develop learning objectives:
Complete the following table that illustrates the statement of learning objectives that can fulfill the desired competencies.

Competency Sub-competency Learning objective

Step 6: Select evaluation procedures
Complete the table below to represent a wide array of evaluation approaches matched to the specific learning objectives
identified for a hypothetical program. The choice of methods will depend upon the length of time and resources available, and
the capacities of both the organization and the teaching team. The evaluation decision should be made about each objective
prior to planning the learning experiences.

40
Step 6: Chart - Select evaluation procedures

Learning Objectives
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P
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,

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t

,
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,

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l

T
e
s
t

41

V. Group Activity: Worksheet, cont.

Step 7: Identify relevant key content
For this example, the following relevant literature from theory and practice have been identified as contributing to the
needed content: (list)

Step 8. Plan the learning experiences
It is only at this point that the planner is ready to map out a sequence of classroom, self-guided or experiential learning
experiences that can take the learner to the desired level of competency. If time allows the faculty might schedule one or more
expert guest lecturers, distribute pertinent materials, and expect the students, by the end of the semester to have critiqued the
current level of achievement of an agency and developed a work plan for subsequent improvement. If time is limited, the number
of competencies might have to be narrowed, along with a different combination of group discussion, reading assignments and
homework assignments related to specific areas of concentration. If a good high-speed internet connectivity is available, the
learners might be asked to download relevant materials from the CDC and other national web sites and apply them to an agency,
with group discussion and expert advice available to support the learning.

Step 9. Deliver Training

Step 10. Evaluate
SECTION TAB

PLACEHOLDER

42

VI. Competencies to Curriculum Example 1.1: Medical Curriculum

EMERGENCY PREPAREDNESS

The competency selected for the example is from the emergency preparedness competencies for graduate medical
students: Initiate patient care within your professional scope of practice and arrange for prompt referral appropriate
to the identified conditions(s).

In this example, the key term is patient care, which is defined as: impairment of normal physiological function affecting part or
all of an organism/an accident that results in physical damage or hurt

The target audience for this training will include students who are enrolled in a medical education program where the
curriculum includes course work such as clinical clerkship.

If these student are to be able to Initiate patient care within their professional scope of practice and arrange for prompt
referral appropriate to the identified conditions(s), that is required for bioterrorism response then they must be able to:
Initiate patient care
Conduct physical exams
Identify patterns of signs and symptoms likely to be associated with occult exposure to CBRNE
Interpret results of the medical history, physical exam, and diagnostic workup to determine an accurate diagnosis of
CBRNE exposure.
Incorporate evidence-based diagnostic procedures and laboratory studies to confirm the diagnoses and/or causative
agents.

43
VI. Competencies to Curriculum - Example 1.1: Medical Curriculum cont.

Step 4. Separate the sub-competencies, cont.

Knowledge of signs and symptoms of acute or delayed critical incident stress reaction among community members
or responders.
Pharmaceutics and pharmaceuticals used to combat CBRNE e.g., burn therapies, biochemical antidotes, antibiotics,
vaccines.
Consider critical aspects of treatment plans for patients who may have been affected physically and/or
psychologically by CBRNE including:
Recognize the need for, and collect and preserve forensic evidence from patients who may be victims of a CBRNE
event

44

The following table illustrates the statement of learning objectives that can fulfill the desired competencies.

1. Take medical histories

a. Determine the absence or presence of symptoms that are
characteristics of exposure to CBRNE
b. Identify patients who may have psychological trauma following
a CBRNE event
c. Identify occupational and psychosocial risks for exposure to
potential CBRNE
d. Characterize exposures to potential CBRNE, including type of
agent, timing, and length of exposure

Initiate patient care
within your professional
scope of practice and
arrange for prompt
referral appropriate to
the identified
conditions(s).
2. Ability to conduct physical
exams
a. Conduct physical exams that are guided by exposure or
potential exposure to CBRNE.
b. Determine the absence or presence of physical signs that are

Table 1.1 presents a wide array of evaluation approaches matched to the specific learning objectives identified for this
hypothetical program. The choice of methods will depend upon the length of time and resources available, and the capacities
of both the organization and the teaching team. The evaluation decision should be made about each objective prior to
planning the learning experiences.

45
Step 6: Table 1.1- Evaluation Procedures

O
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t
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W
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T
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T
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s
t

1. Determine the absence or presence
of symptoms that are characteristics
of exposure to CBRNE
X X X
2. Identify patients who may have
psychological trauma following a
CBRNE event
X X X
3. Identify occupational and
psychosocial risks for exposure to
potential CBRNE
X X X
4.. Characterize exposures to potential
CBRNE, including type of agent,
timing, and length of exposure
X X X
5. Conduct physical exams that are
guided by exposure or potential
exposure to CBRN.
X
6. Determine the absence or presence
of physical signs that are
X X

46


For this example, the following relevant literature from theory and practice have been identified as contributing to the needed
content:
Hospital Provider Course- Defense against WMD - Office for Domestic Preparedness

Compendium of acute food borne and waterborne diseases - CDC, Epidemiology Program Office; 2003

Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed
Forces Radiobiology Research Institute Bethesda, Maryland 20889 5603; Accessed April, 2003;
http://www.afrri.usuhs.mil

Dept of Homeland Security Working Group on Radiological Dispersal Device (RDD)
Preparedness Medical Preparedness & response Sub-Group - Dept. Of Veteran Affairs, Dept.

An Epidemic of Thyrotoxicosis- Instructors Guide - CDC and Prevention Epidemiology Program office, case studies
in applied Epidemiology No. 873-703-Dept. of Health and Human Services/EIS 2003.

Smallpox Clinical Poster - Dept. of Health and Human Services, Center for Disease Control and Prevention.

Oswego An Outbreak of Gastrointestinal Illness Following a Church Supper, Students Guide -CDC and Prevention-
Epidemiology program office case studies in applied Epidemiology No. 401-303.

Suspected Legionnaires disease in Bogalusa- Instructors Guide, Students Guide - CDC- Epidemiology Program
Office- Case studies in applied Epidemiology No. 912-303- Dept of Health and Human Services/EIS 2003

47


experiences that can take the learner to the desired level of competency. If possible the trainer might schedule one or more
expert guest lecturers. If only a portion of the course were available, the number of competencies might have to be narrowed,
along with a different combination of group discussion, reading assignments and homework assignments related to specific work
units. If the school has good high-speed internet connectivity, the learners might be asked to download relevant documents from
the CDC or DHS web site and apply them to his or her clinical site, with group discussion and expert advice available to support
the learning.

SUBSECTI ON COLOR PAGE
PLACEHOLDER

48
VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum


The competency selected for the example is from the emergency preparedness competencies for accelerated program
nursing students: describe your expected role in emergency response in the specific practice setting as part of the institution
or community response.

In this example, the key term is emergency response, which is defined as: the complete range of activities included in an
agency plan that allow for management of a possible terroristic event or disaster.

The target audience for this training will include students who are enrolled in a nursing education program where the
curriculum includes course work such as professional issues, Pathophysiology, pharmacology epidemiology.

If these student are to be able to define modifications to the agencys internal command notification and coordination
structure that are required for bioterrorism response then they must be able to:
Describe the agencys basic notification structure
Describe the differences between bioterrorism response and other emergency response
Analyze application of bioterrorism response to the usual notification structure
Define a modified command structure

49
VI. Competencies to Curriculum - Example 1.2: Nursing Curriculum, cont.


Describe the agencys basic
notification structure

Describes the uses of a notification structure
Define the difference between an organizational chart and a
notification structure
Define the role of command in emergency response
Describe the differences
between bioterrorism
response and other
emergency response
Articulate the principles of emergency response
Describe the variation in response needed for a bioterrorist
event
List the participants in community emergency response
Define the role of nurse in emergency response
Analyze application of
bioterrorism response to the
usual notification structure
Identify the potential risks in using the ordinary notification
structure in a bioterrorism event
Describe the partners in bioterrorism response at a
community level
Specify the key junctures at which a different notification or
command response could be useful
Describe your expected
role in emergency
response in the specific
practice setting as part of
the institution or
community response.
Define a modified command
structure
Specify the changes in notification needed for bioterrorism
response
Define the command structure for a hospital
Present an agency-specific emergency notification and
command structure sufficient for a bioterrorism event


50
Table 1.2 Evaluation Procedures

Learning Objectives
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,

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,

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t
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l

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b
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s
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r

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u
a
t
o
r

S
i
t
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a
t
i
o
n
a
l

T
e
s
t

1.a. Describes the uses of a notification
structure X X X
1.b. Define the difference between an
organizational chart and a notification structure X
1.c. Define the role of command in emergency
response X
2.a. Articulate the principles of emergency
response X X X
2.b. Describe the variation in response needed
for a bioterrorist event X
2.b. List the participants in community
emergency response X
2.c. Define the role of nursing in emergency
response X
3.a. Identify the potential risks in using the
ordinary notification structure in a bioterrorism
event X
3.b. Describe the partners in bioterrorism
response at a community level X
3.c. Specify the key junctures at which a
different notification or command response
could be useful X
4.a. Specify the changes in notification needed
for bioterrorism response X
4.b. Define the command structure for a
hospital X
4.c. Present an agency-specific emergency
notification and command structure sufficient
for a bioterrorism event X X

51

For this example, the following relevant literature from theory and practice have been identified as contributing to the needed
content:
FEMA Independent Study Program: IS-100 Introduction to Incident Command System, I-100. Available at:
http://training.fema.gov/EMIWeb/IS/is100.asp
FEMA Independent Study Program: IS-700 National Incident Management System (NIMS), An Introduction.
Available at: http://training.fema.gov/EMIWeb/IS/is700.asp

National Incident ManHospital Provider Course- Defense against WMD(52)- Office for Domestic Preparedness
Management System(37)

DHS WMD Awareness Course (50)- U.S. Dept. of Homeland Security, Office for Domestic Preparedness, Center for
Domestic Preparedness

Arnold J L. Dembry LM. Tsai MC. Dainiak N. Rodoplu U. Schonfeld DJ . Paturas J . Cannon C. Selig S.
Recommended modifications and applications of the Hospital Emergency Incident Command System for hospital
emergency management. [J ournal Article] Prehospital & Disaster Medicine. 20(5):290-300, 2005 Sep-Oct.

J acoby IJ . SARS and the Hospital Emergency Incident Command System (HEICS): outbreak management as the
mother of invention. [Editorial] J ournal of Emergency Medicine. 28(2):225-6, 2005 Feb.

Zane RD. Prestipino AL. Implementing the Hospital Emergency Incident Command System: an integrated delivery
system's experience. [J ournal Article] Prehospital & Disaster Medicine. 19(4):311-7, 2004 Oct-Dec.

52


the learning.

PLACEHOLDER

53
VI. Competencies to Curriculum - Example 1.3: Dental Curriculum


The competency selected for the example is from the emergency preparedness competencies for graduate dental students:
Recognize an illness or injury as potentially resulting from exposure to a chemical, biological, or radiological/nuclear (CBRN)
agent possibly associated with a terrorist event.

In this example, the key term is illness/injury, which is defined as: impairment of normal physiological function affecting part
or all of an organism/an accident that results in physical damage or hurt

The target audience for this training will include students who are enrolled in a medical education program where the
curriculum includes course work such as pathophysiology, pharmacology epidemiology (dental).

If these student are to be able to recognize an illness or injury as potentially resulting from exposure to a chemical, biological,
or radiological/nuclear (CBRN) agent possibly associated with a terrorist event, that is required for bioterrorism response
then they must be able to:

Describe the major classes of chemical, biologic, radiological, nuclear and explosive agents that can be used as terrorist
weapons.
Describe the basic principles of selection and use of personal protective equipment appropriate to a range of situations typical of
one's profession.

54
VI. Competencies to Curriculum - Example 1.3: Dental Curriculum, cont.


Describe the major classes of
chemical, biologic, radiological,
nuclear and explosive agents
that can be used as terrorist
weapons.

a. Describe Category A biologic agents, including epidemiology, routes
of exposure, treatments and infection control principles.
b. Describe general classes of potential chemical weapons, including
mechanisms of exposure, decontamination and treatment principles
and concepts of personal protection.
c. Describe types of radiation associated with potential terrorist devices,
including mechanisms of distribution, effects of exposure, treatment
and personal protection.

Recognize an illness or
injury as potentially
resulting from exposure
to a chemical, biological,
or radiological/nuclear
(CBRN) agent possibly
associated with a
terrorist event, that is
required for bioterrorism
response
Describe the basic principles
of selection and use of personal
protective equipment
appropriate to a range of
situations typical of one's
profession.

Demonstrate use of personal protective equipment appropriate to a
range of situations typical of one's profession.


55
Table 1.3 Evaluation Procedures

Learning Objectives
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n

T
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y

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n

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t

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u
a
t
i
o
n
a
l

T
e
s
t

1. Describe Category A biologic
agents, including epidemiology,
routes of exposure, treatments and
infection control principles. X X X
2. Describe general classes of
potential chemical weapons,
including mechanisms of exposure,
decontamination and treatment
principles and concepts of personal
protection. X
3. Describe types of radiation
associated with potential terrorist
devices, including mechanisms of
distribution, effects of exposure,
treatment and personal protection. X
4. Demonstrate use of personal
protective equipment appropriate to a
range of situations typical of one's
profession. X

56

For this example, the following relevant literature from theory and practice have been identified as contributing to the
needed content:
Terrorist CBRN Materials & Effects - Central Intelligence Agency- May 2003

Criminal and Epidemiological Investigation Handbook - 1. U.S. Dept. of J ustice, 2. Federal

Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed
Forces Radiobiology Research Institute Bethesda, Maryland 20889 5603; Accessed April, 2003;
http://www.afrri.usuhs.mil

Managing Hazardous Materials Incidents- A Planning Guide for the Management of Contaminated Patients - A three
volume series, Agency for Toxic Substances and Disease Registry; March 2001

Hospital Provider Course- Defense against WMD - Office for Domestic Preparedness

Bioterrorism Readiness Plan: A Template for Healthcare Facilities, APIC Bioterrorism Task

Aid for Decontamination of Fire and Rescue Service Protective Clothing and Equipment After Chemical, Biological,
and Radiological Exposures - Lawson, J . Randall, J arboe, Theodore L. National Institutes of Standards and
Technology(NIST) Special Publication 981, US Dept of Commerce, May 2002

57

the learning.

SECTION TAB

PLACEHOLDER

58
VII. Incorporating Competencies and Content into Existing Course Curricula
Example 2.1: Medicine
Competency Content

Curriculum/Course
II. Terrorism and
Public Health
Emergency
Preparedness

1. Chemical biologic,
radiological, and
explosive agents.

1a. Describe the major
classes of chemical,
biologic, radiological,
nuclear and explosive
agents that can be
used as terrorist
weapons.
Biologic: bacterial, viral, rickettsial, intoxictions;
Chemical: nerve agents, blister agents, blood
agents, choking agents, irritants;
Nuclear/Radiological: alpha, beta, gamma, electro-
magnetic pulses, dispersal devices; Explosive:
trauma patterns

2. Biologic agents
2a. Describe Category
A biologic agents,
including
epidemiology, routes
of exposure,
treatments and
infection control
anthrax, tularemia, cholera, plague, botulism,
encephalitis
Pathophys I (microbiology):
anthrax, cholera, botulism,
smallpox; viral hemorrhagic
fevers may be added next
year

59
principles.
2b. Describe
knowledge of Category
B biologic agents.
brucellosis, clostridium, salmonella, Q fever, typhus,
staph
Pathophys I (microbiology):
C. perfringens, salmonella/GI,
typhus, staph
3. Chemical agents
3a. Describe the
general classes of
potential chemical
weapons, including
mechanisms of
exposure,
decontamination and
treatment principles
and concepts of
personal protection.
organophosphates (sarin, soman, tabun, v-agent);
mustard agents / corrosives; blistering agents; blood
agents (hydrogen cyanide, cyanogen chloride)
choking agents (chlorine, phosgene); irritants
(chloropicrin, mace, tear gas, capsicum/pepper
spray, dibenzoxazepine)
Pharmacology:
organophosphates, mustard
agents (only for oncology Rx)
4. Radiological
agents

60
4a. Describe types of
radiation associated
with potential terrorist
devices, including
mechanisms of
distribution, effects of
exposure, treatment
and personal
protection.
alpha (inhalation, ingestion, injection); beta
(dermatologic), gamma (greatest danger),
electromagnetic pulses (damage to electrical
systems)
Pathophys II (oncology): brief
overview of radiation
oncology but only as
therapeutics
5. Personal
Protective
Equipment and
Decontamination

5a. Demonstrate basic
principles of selection
and use of personal
appropriate to a range
of situations typical of
one's profession.
definitions, levels A-D, need for training and fitting,
respiratory devices (SCBA, supplied-air respirators,
air-purifying respirators, HEPA filters, surgical
masks); chemical protective clothing, surgical gowns,
latex gloves, M40 Mask, battle-dress over
garments, chemical protective gloves

PLACEHOLDER

61
Example 2.2: Nursing

Competency Content Curriculum/Course
II. Terrorism and
Public Health
Emergency
Preparedness

radiological, and
explosive agents.

1a. List the major
agents that can be
used as terrorist
weapons.
Chemical: nerve agents, blister agents, blood agents,
choking agents, irritants; Nuclear/Radiological: alpha,
beta, gamma, electro-magnetic pulses, dispersal
devices; Explosive: trauma patterns

2. Biologic agents
2a. Demonstrate
knowledge of Category
A biologic agents,
including
of exposure,
encephalitis, viral hemorrhagic fevers
Microbiology or Med Surg

62
treatments and
infection control
principles.
2b. List Category B
biologic agents.
staph
Microbiology or Med Surg
3. Chemical agents
3a. Demonstrate
knowledge of general
classes of potential
chemical weapons,
including mechanisms
of exposure,
decontamination and
and concepts of
agents (hydrogen cyanide, cyanogen chloride) choking
agents (chlorine, phosgene); irritants (chloropicrin,
mace, tear gas, capsicum/pepper spray,
dibenzoxazepine)
Pharmacology
4. Radiological
agents

devices, including
mechanisms of
exposure, treatment
and personal
protection.
electromagnetic pulses (damage to electrical systems)
Med Surg

63
5. Personal
Protective
Equipment and
Decontamination

and use of personal
one's profession.
air-purifying respirators, HEPA filters, surgical masks);
chemical protective clothing, surgical gowns, latex
gloves, M40 Mask, battle-dress over-garments,
chemical protective gloves
Clinical Skills Lab
Professional Development
5b. Describe principles
and application of
decontamination
5:1 ratio unaffected to affected; need for immediate
decontamination; disrobing as decontamination (head
to toe, more better); water flushing best mass
decontamination method; need to decontaminate
emergency responders; reservation of decontaminant
as evidence

PLACEHOLDER

64
Example 2.3: Dentisrty
Competency Content Curriculum/Course
II. Terrorism and
Public Health
Emergency
Preparedness

radiological, and
explosive agents.

1a. Describe the major
agents that can be
used as terrorist
weapons.
Chemical: nerve agents, blister agents, blood agents,
choking agents, irritants; Nuclear/Radiological: alpha,
beta, gamma, electro-magnetic pulses, dispersal
devices; Explosive: trauma patterns

2. Biologic agents
2a. Describe Category
A biologic agents,
including
of exposure,
treatments and
infection control
principles.
encephalitis, viral hemorrhagic fevers
Pathophysiology

65
2b. Describe Category
B biologic agents.
staph
Pathophysiology
3. Chemical agents
3a. Describe general
classes of potential
chemical weapons,
including mechanisms
of exposure,
decontamination and
and concepts of
agents (hydrogen cyanide, cyanogen chloride) choking
agents (chlorine, phosgene); irritants (chloropicrin,
mace, tear gas, capsicum/pepper spray,
dibenzoxazepine)
Pharmacology
4. Radiological
agents

devices, including
mechanisms of
exposure, treatment
and personal
protection.
electromagnetic pulses (damage to electrical systems)
Pathophysiology
5. Personal
Protective
Equipment and
Decontamination

66
and use of personal
one's profession.
air-purifying respirators, HEPA filters, surgical masks);
chemical protective clothing, surgical gowns, latex
gloves, M40 Mask, battle-dress over-garments,
chemical protective gloves
Clinical Skills Lab
Professional Development

SECTION TAB

PLACEHOLDER

67
VIII. Sample Syllabus 1.1: Medicine
Consider where to incorporate Emergency Preparedness Competencies within this sample

Introduction

General Course Information:
MEDI M7201.083 CLINICAL CLERKSHIP IN MEDICINE

Instructor Information:
XXXXX
E-mail: XXXXX
Overview
The clinical clerkship in Medicine is an intensive ten week introduction to internal medicine. You will spend five
weeks at XUMC and five weeks at one of the affiliated hospitals. At each site, in addition to your team of house
officers and attendings you will have a preceptor who will be responsible for didactic sessions, feedback, the
observed history and physical, and reading your write-ups.

The in-patient experience will allow you to see a wide variety of patientsnot only your own, whom you will know
in depth, but the others on your team, and those of the other students in your preceptor group. This will help you
broaden your fund of knowledge even in these brief ten weeks. Even more importantly, every day will provide
multiple opportunities to practice your interviewing and physical diagnosis skills, animate your knowledge of basic
and clinical science, and experience your emerging identity as a physician as you apply yourself to the task of
caring for sick patients. To fully integrate the knowledge, skills, and professional attitudes will take time, hard work
and practice. Work with each of your patients closely. Let the patient teach you about the person and about the
disease. Watch everyone -- medical staff, nursing staff, social workers, ward clerks, etc. Watch their interactions
with patients and with each other. Select those approaches and presentations that you find most effective,
appropriate and helpful in caring for your patients. It is normal to feel overwhelmed at first, but call for help, if you
are having difficulty understanding your role and your priorities.

68

The clerkship is, in part, an apprenticeship. It is an opportunity to work with the patients and to learn from them
with the luxury of not having direct, final responsibility for their management. It will not always be so, so take full
advantage of the fact that you are still a student and take time to read, prepare your write-ups, and prepare for
your preceptor group. You will need to balance two demands on your time and two sources of learning, your ward
team and your preceptor.
If you have problems, concerns, questions, or if anything seems "WRONG", or even not as good as it should
be, please contact Dr. XXXX.
Expectations and Requirements:
1. Each student should actively participate in the care of at least 10 patients during each of the five weeks. ---
/////You will work closely with an intern and resident and will be "on call" admitting and working up new patients
/////approximately every fourth day. You should work up one patient per call (prepare to present the patient on
/////attending rounds the following day, and do a formal write-up for your preceptor) and if possible pick up another
/////patient to follow (this will be easier as the rotation progresses).
2. Each student should be following 2-4 patients at any given time
3. Each student is responsible for handing in six full write-ups to their preceptor for each of the five weeks of
/////the clerkship. These are due no later than 48 hours after the day "on call" and must all be handed in by the last
/////day of the five weeks. (see assignments for sample write ups)
4. Each student will be responsible for entering the data on their patients into the Patient Encounter system.
/////Over the course of the clerkship at a minimum you should be exposed to patients and learn in depth about the
/////following diagnostic categories and differentials:
/ Constitutional signs and symptoms (fever, wt loss, fatigue)
//Chest Pain
//Shortness of Breath
//Abdominal Pain
//Gastrointestinal Bleeding
/Liver disease
Renal insufficiency/failure
Electrolyte and acid-base disorders
Anemia

69
Clotting disorders
Diabetes
Dizziness and syncope
HIV
Malignancy
You should have opportunities to observe, perform, and practice the following:
EKG interpretation
CXR interpretation
Blood drawing
IV placement
Skin testing (e.g. PPD)
Counseling re health behaviors: smoking cessation, alcohol and other substance abuse, diet
Breaking bad news
End of life issues
Educating patients and families about diagnosis and/or chronic disease
5. Each student will discuss midpoint feedback with their Preceptor and the form (see assignments) will be
///submitted by the Preceptor.
6. Each student will do an observed history and physical examination with their Preceptor who will complete the
///form. (see assignments).
7. The last day of the 10-week clerkship the shelf examination in Internal Medicine will be given. This will
///contribute approximately 10% toward the final grade.

Goal: The goal of the clerkship is to develop competencies in the basic knowledge, skills and attitudes of an
effective clinician in evaluating and caring for hospitalized adult patients

70
At the end of this clerkship, students will be able to demonstrate competencies in the basic knowledge, skills and
attitudes of an effective clinician in evaluating and caring for hospitalized adult patients.
Objectives

Methods/Opportunities/Evaluators
Medical Knowledge

Medical Knowledge

Develop and expand core medical
knowledge: Presentation,
mechanisms, natural history, and
treatment of common diseases in the
inpatient setting (Competency 3)

Develop and expand knowledge of
differential diagnosis of presenting
signs, symptoms and laboratory
abnormalities in inpatient setting
(Competency 5)

Major resources:
Textbook of Medicine: Harrisons is on-line
Pathophysiology syllabus and other material from Pre clinical curriculum
Pub med is on line for researching specific topics

Identify areas of incomplete core knowledge based on ones own
patients, those of the team and other students in preceptor group. Total
patient exposure at least 20 direct patient care, >50 indirect (discussed
in preceptor group, on rounds, etc)

Read, focusing on presentation, mechanisms of disease, natural
history, and treatment and
Differential diagnosis and approach to the patient with a presenting
complaint

Weekly CPCs at XUMC: preparation with course director; presentation
of students formulation at Departmental conference is an exercise in
diagnostic reasoning and differential diagnosis

Review and learn interpretation of most frequent diagnostic tests:
laboratory studies, echocardiography, pulmonary function studies in
preceptor group
EKG interpretation-- 5 sessions/ five weeks Radiology--5 sessions/ five
weeks (varies by site)

71
Develop and expand knowledge of
diagnostic testing and skills in clinical
reasoning that lead to differentiating
among diagnoses for complaints in
the in patient setting

Depth of knowledge:
Demonstrate and share
understanding of basic
pathophysiologic and/or
pharmacologic mechanisms

Demonstrate motivation and skills in
life long learning
Actively formulate questionson
rounds, in preceptor group, and
pursue answers
Review and present pathophysiology and pharmacologic basic
mechanisms on attending rounds and in preceptor group

After reading the foundations: ask questions always, of everyone:
house officers, attendings, consultants, preceptors. If no one is sure of
the answer, look up what you can and educate the group

Evaluators: House officers, attendings, preceptors

Patient care: Data gathering,
synthesizing and reporting
(Competency 7)
Patient Care: Data gathering, synthesizing and reporting
Be able to obtain a complete and
accurate admission history
Be able to obtain a focused interval
history on a daily basis

Perform an accurate, complete
physical examination
Perform a focused physical
examination appropriately guided by
Perform a complete history and physical examination on all admitted
patients (minimum 20 in the 10 weeks) this includes all components of
the history as listed on the Atchley form, and in addition gathering any
additional information from records and outside sources e.g.
physicians, and other hospitals

Perform a focused interval history on a daily basis for all admitted
patients (average two per day).

72
the patients diagnosis and evolving
illness

Be able to summarize the case and
the main findings of each case in a
succinct sentence
Develop an appropriate, and
prioritized differential diagnosis for the
presenting and other significant
problems of the patient
Create a problem list
Formulate a prioritized diagnostic
strategy
Formulate a treatment strategy
(Competency 6)

Clinical skills: Practice basic skills
with appropriate supervision from
house staff: blood drawing, starting
IV's, skin testing (PPD)

Perform an observed history and physical examination with your
preceptor
Present/review findings with resident and prepare the formulation and
differential diagnosis for formal presentation on attending rounds.
These presentations are to be made at the bedside from memory.

Complete write-ups (at least six per five weeks) to be turned in to
Preceptor and returned with feedback in 48 hours. Present patients in
preceptor group in both complete and abbreviated formats.

Present/review findings with house staff and present on attending
rounds

Write daily notes, review with house staff.

Feed back and Evaluation: House officers, attendings, and preceptors
all see different stages of the process and provide feedback and
evaluation on each aspect of the students progress
Interpersonal and communication
skills (Competencies 8, 9)

Interpersonal and communication skills

Be able to establish a therapeutic
relationship: some of the specific
skills include:
Always think about the multiple
perspectives model:
Observe others and practice the multiple perspectives model yourself;
all clinical encounters offer opportunities

Practice communicating with patients and families

73
-Identify the patients perspective, as
well as those
of family members
-Identify your own perspective
-Identify barriers to successful
communication
-Choose to put the patients needs
first
-Create a comfortable environment
-Sit down when possible
-Ask open ended questions
-Be dependable and help set realistic
expectations
-Communicate effectively with
patients and families
-Be able to summarize and explain to
each patient their illness, diagnostic
tests, treatments and the anticipated
risks and benefits.

Be able to identify key issues to
address at the end of life and acquire
basic skills in talking to patients about
end of life issues and choices.

Be able to address patients health
behaviors: identify teachable
moments, and reinforce skills in
behavior change (Competency 10)

Communicate effectively and work

Clinical Practice (XUMC) and Psychiatry sessions (away sites) focus on
end of life, difficult patients, effecting behavior change, ethics and
professional development

Evaluators: House officers, attendings, preceptors, clinical practice and
psychiatry preceptors

74
with other members of the team
Identify your role with house officers,
attendings, preceptors
Communicate effectively with social
workers, nurses and others
Be collegial and helpful to fellow
students
Communicate effectively with other
consulting services

Professionalism

Professionalism

Demonstrate altruism and motivation
to provide effective patient care

Continuously reflect on, discuss, and
expand your model of the doctor-
patient relationship

Steadily advance in level of
responsibility towards patients: third
year clerks should be interpreters and
managers, and prove themselves
capable of closely supervised
independence (Competency 11)
Observer: watches what happens
Reporter: describes what happens,
gathers information accurately
Interpreter: synthesizes data from
multiple sources and formulates a
differential diagnosis
Clinical Practice3: assignment is to consider the doctor-patient
relationship and how a specific patient or encounter challenged or
expanded your concept of that role. With the Clerkship Director and the
Clinical Practice 3 Course Director we will discuss the themes that each
students case raises

Evaluators: House officers, attendings, preceptors, course director

75
Manager: based on the interpretation,
can predict and anticipate the
possible course of illness and act
accordingly
Practice-based learning Practice-based learning

Read effectively, be curious, and ask
questions about all aspects of the
care rendered to their patients:
medical knowledge, clinical
reasoning, and doctor-patient
relationships

Observe and reflect on all members
of the team, their, knowledge,
professionalism, and relationships
with patients

See Medical Knowledge above. Learn from everyone: not just
knowledge but skills and attitudes

Evaluators: house officers, attendings, preceptors
Systems-based practice

Systems-based practice

Work effectively with all other health
care professionals (Competency 5)
Observe and reflect on the systems
issues that impact in patient care

Communicate about near misses or
errors to others (chief resident,
attendings, preceptors) so that human
errors and system errors can be
reviewed in appropriate context.
Observe others and develop ones own effective skills in team work

Evaluators: house officers, attendings, preceptors

Source available at: http://www.columbia.edu/itc/hs/medical/curriculum/course_online/

PLACEHOLDER

76
VIII. Sample Syllabus 1.2: Nursing

NXXX - THE SCIENCE OF NURSING PRACTICE IN THE COMMUNITY

CREDITS: 3.0 FALL 2005

HOURS & LOCATION: Monday 8:00 11:00 a.m. & 12:00 3:00 p.m.
Medical Science Pavilion

Tuesday 8:00 11:00 a.m.
XXXX Cancer Research Center 115

COURSE DIRECTOR: xxx
xxx
xxx
xxx

PREREQUISITE: Successful completion of the first semester of the program

CO REQUISITE: NXXX Nursing Practice in the Community

DESCRIPTION: This course focuses on the role of the nurse in community health: caring for aggregate
populations at risk and the community as a whole. Nursing science and epidemiology provide
the base for examining the spectrum of community health. Tools for community assessment
and diagnosis as well as concepts of health promotion, disease prevention, risk reduction and
rehabilitation and evidence-based practice for the health of groups are presented.

77
VIII. Sample Syllabus 1.2: Nursing, cont.

OBJECTIVES: At the completion of the course, the student will be able to:

1. Identify health status indicators involved in community or population group assessment upon which to
determine working diagnoses for community nursing interventions

2. Formulate evidence-based plans for care of families and groups in diverse community settings,
integrating concepts of bio-behavioral and epidemiologic sciences in the plan

3. Examine the impact of acculturation and cultural heritage on the community health care needs of
specific aggregate groups

4. Analyze research findings relevant to needs of specific community groups at high risk for illness,
disability or poor recovery

5. Evaluate efficacy of health promotion and education modalities used in community settings with
diverse populations

6. Discuss the relationship of public health and community health nursing sciences on the practice of
community health

7. Discuss the legal and ethical challenges of community health nursing practice

METHODOLOGY: Lecture, case studies, assignments

EVALUATION: Community Assessment Presentation 40%
Midterm 25%
Final Exam 35%

78


REQUIRED TEXT(S): McKenzie, J . F., Pinger, R. R., Kotecki, J . E. (2004). An
introduction to community health (5
th
ed.).
Sudbury, MA: J ones and Bartlett Publishers.

RECOMMENDED TEXT(S):

Kidder, Tracy (2004). Mountains beyond mountain, the quest of
Dr. Paul Farmer, A Man Who Would Cure The World.
New York, NY: Random House Publishers.
ISBN: 0812973011

Kozol, J onathan (1996). Amazing grace: lives of children and the conscience of a nation. New
York, NY: Harper Perennial.
ISBN: 0060976977

LeBlanc, Adrian (2003). Random family: love, drugs, trouble and coming of age in the Bronx.
New York, NY:
Scribner Publishers.
ISBN: 0743254430

SUGGESTED TEXT(S): Clark, M.J . (2002). Community health nursing: caring for
populations (4
th
ed.). Prentice Hall.
ISBN: 0130941492

79

COURSE POLICY: 1. Class attendance and participation are required.

2. Any student who will miss an exam must notify faculty
////before the exam. Failure to do so will result in a grade of 0 on the exam.

3. You must pass the clinical co-requisite in order to progress
////in the program.

4. All papers must be written using APA format.

80
CONTENT OUTLINE:

Week 1
Brief history of community health and public health (Competencies 8, 9)
Organizations in community health
Introduction to Epidemiology in Community Health
Community Assessment & intervention principles
Health Education in the community
Emergency preparedness and disaster preparedness at the community level (Competencies 1, 2)

Week 2
School Health
Asthma in the community: applying principles of surveillance, health education & public health in the community.
Environmental health and Occupational health: applying principles of surveillance, health education & public health in the
community. (Competency 5)
Contraception in the community: applying principles of surveillance, health education & public health in the community.
Sexually transmitted diseases: applying principles of surveillance, health education & public health in the
community.

Week 3
International comparative healthcare systems, International infectious disease
Communicable disease & Immunization: applying principles of surveillance, health education & public health in the
community. Focus on Tuberculosis.
Hepatitis: applying principles of surveillance, health education & public health in the community. (Competency 3)
Vector born illness: applying principles of surveillance, health education & public health in the community. (Competency 4)
Malnutrition & GI parasitology: applying principles of surveillance, health education & public health in the community.

Week 4
Violence in the community
Domestic Violence
Drug and Alcohol Abuse
Caring for correctional communities
Foster care

81

Week 5
Domestic HIV/AIDS, HIV counseling and testing
Health insurance/ Medicaid & Medicare
Final Exam review
Final Exam

Guidelines for Community Assessment and Intervention Project:
Please submit topics on the second Tuesday of class via email for written approval by Professor XXXXX. The due date for each
groups presentation will be assigned on the first day of class.
Part 1: Community Assessment

Objective
To introduce the class to the community for which you have designed your intervention.

Method
Lecture format with Power Point
Not to exceed fifteen (15) slides and not to exceed ten minutes presentation time.

Directions
Assess a community that one or more of the students in the group is exposed to in community clinical rotation. You may do
an assessment of the health care provider community or the patient/health care recipient community. You may request
approval to assess a community outside the scope of your group members community placements. An example of this
would be an international or historical community.
At least two (2) students should present the power point portion of this assignment
The power point presentation should include the following:
References: please choose current sources, specific to your community. Data obtained via a community
assessment interview process is ideal (minimum n=10). Data obtained from reliable community resources (ie.
Providers on site) is highly appropriate, but should be reviewed for accuracy by the group.
Epidemiological overview of community (4 relevant statistics)
Factors affecting health of the community
o Physical and environmental factors (2)
o Social and Cultural Factors (2)

82
Needs and strengths of community (2 to 4 of each)
Summary slide of developmental, psychosocial, and socioeconomic status of the community. Include literacy level
here.
Define the gatekeepers of the community (2)
How can this community be organized for change? Please discuss a potential grassroots initiative. (1)
Define the roles of the community health nurse within the community. (2 to 3)
Give examples of evaluation methods for community health nurse interventions. (2 to 3)
Please prepare a printed version of the power point (6 slide to a page format) for submission to Professor XXXX at the
time of your presentation.
Resources: Please refer to chapters 1,3 and 5 in the required text.

Part 2: Community Intervention

Objectives
To design, implement and evaluate a real life community intervention based on the health education concepts discussed in
class.
To gain proficiency in your current role as student nurse educator and potential future role as community health nurse and
nurse educator.
To have the class gain insight, understanding and cultural awareness regarding unique and potentially high risk populations
or target groups.

Method
General class instruction (Non-traditional instruction formats may be appropriate)
Not to exceed twenty (20) minutes presentation time

Directions
Present a health education intervention to the class, as though the class is the community you assessed in Part 1 of this
project.
At least two students (different than those students who presented in part 1) should present the intervention portion of this
assignment.
Group participants who are not presenting as student nurse educators may be dispersed throughout the audience and ask
questions or voice opinions and concerns that may represent the community being addressed. All group members should
be culturally competent and maintain a high level of cultural sensitivity during this process.
Group participants who are not presenting as student nurse educators may represent educators of other disciplines.

83
Dissemination of large amounts of health information should be followed up with a written document. Please create an
original document at the appropriate literacy level for this community and be prepared with 35 copies for class distribution. If
your target group cant read, it may be feasible to use a picture document.
Conclude the intervention with an appropriate evaluation tool.
This intervention must indicate that an appropriate developmental, psychosocial and socioeconomic assessment
has been performed. *****
Creativity is welcome!

In total your group presentation should not exceed 30 minutes! The trick to the power point component is simplicity! NO MORE
THAN 15 SLIDES PLEASE.
PLACEHOLDER

84
VIII. Sample Syllabus 1.3: Dentistry

Oral Public Health and Community Service Program, Summer 2005

This course addresses the following questions:
What are Public Health, Civic Engagement, and Community Service, and how do they relate to general health and
well-being?
What are the fundamentals of epidemiology and biostatistics and what are their practical applications in general
health and healthcare?
Why are oral health and oral healthcare access major public health issues world-wide?
How do the oral public health issues of water fluoridation, mercury disposal, HIV/AIDS, cancer, and tobacco use
impact general health and well-being?
How can the strategies and methods of community-based healthcare systems development make a positive impact
on oral health and oral healthcare access?
Course Description
This program examines the impact of society, disparate cultures, attitudes, health beliefs and risk behaviors on oral public
health. The fundamental principles and practices of public health, epidemiology, civic engagement, and community
service are presented from a practical and applied perspective. The significance of oral diseases and disorders as a
silent epidemic and their grave impact on general health and well-being is emphasized, including specific examples of
current issues and hot topics in oral public health. Strategies and methods to overcome existing substantial impediments
to oral healthcare access for the most needy, vulnerable and underserved populations, is discussed from the perspective
of community-based healthcare systems development. The course is principally a lecture/seminar format, with readings,
case studies, assigned learning experience project and final paper. Students are expected to participate actively in class
discussion.

85
VIII. Sample Syllabus 1.3: Dentistry, cont.
Please note that the course as presented here does not contain the full content of the course as taught at Tufts. The
included content is based on material the Tufts faculty and instructors choose to include, as well as factors such as
content preparation, software compatibility, and intellectual property and copyright restrictions.

Objectives
Demonstrate a broad understanding of the underlying factors influencing public health and oral public health,
including social, cultural, behavioral, economical and political determinants of health.
Apply the principles and practices of epidemiology, statistics and the behavioral sciences to oral public health and
to critical review of the scientific literature.
Describe the types of research designs used for descriptive, analytic, and experimental inquiry.
Describe evidence-based clinical practice and reis assessment and their application to clinical dentistry.
Describe the major issues and obstacles in oral public health, and their possible resolutions.
Demonstrate an understanding of the principles and practices of planning, developing, implementing and
evaluating oral health care delivery systems.
To develop the student's civic engagement, social and cultural awareness and knowledge and skills needed to
provide quality oral health care services to underserved populations.
To develop the students' professional and ethical growth by providing compassionate quality oral health care to
disparate, underserved, and disadvantaged patient populations.

1. Grading and Assessment
Three case studies periodically assigned during the academic term 25%
ALE Final Paper25%
Final written exam50%

86
VIII. Sample Syllabus 1.3: Dentistry, cont.

Lectures

1. Overview
2. The Science of Public Health: Epidemiology and Biostatistics Competencies 2, 6)
3. Issues and Hot Topics in Oral Public Health (Competencies 1, 2, 11)
4. Oral Public Health Strategies and Methods (Competencies 4, 5, 7)

Oral Public Health - Stand-Alone Assignments
Author: XXXX
1. Applied Learning Experience (ALE) Final Paper
Students will submit a final paper documenting a public health/community service (PH/CS) research project, a practical
PH/CS experience or project they are or have recently been involved in, or a literature review on a relevant current PH/CS
issue. Further details, guidelines and suggestions for the final paper will be provided to students under separate cover.
The ALE final paper will count toward 25% of the grade.

Original syllabus found at http://ocw.tufts.edu/Course/11/Coursehome

SECTION TAB

PLACEHOLDER

87
IX. Resources:
Columbia University - Common Competencies in Emergency Preparedness for the Health Sciences

Competency School Specific Language
School of Public Health School of Nursing
School of Dental and Oral
Surgery
College of Physicians
and Surgeons
I. Emergency Management
Principles

1. Phases of disaster
management
Explain Describe Describe Describe
2. Hazards risk assessment
a. Concept Explain Explain Describe Describe
b. Methods Explain Describe Describe Describe
c. Uses Explain Describe Describe Describe
3. Response Functional Roles
a. Role of the citizen ,
community, volunteers, and
various health sectors and
agencies in disaster planning
and response.
b. Concept of disaster response
functional role, and the disaster
response functional role for
one's profession.
Explain Explain Demonstrate Describe
c. Ability to perform basic
disaster response functional
roles that are commonly used in
one's profession.
Apply (depending on
department and what is meant
by roles)
Demonstrate Demonstrate Demonstrate
d. Importance of maintaining
expertise and knowledge in this
area of practice, and
participating in emergency
response drills.
Explain Discuss Describe Describe

88
Surgery
and Surgeons
e. Ability to apply knowledge
and experience to new situations
that are posed by the
emergency without exceeding
authority or capabilities.
Explain Demonstrate Demonstrate Demonstrate
f. Importance of personal and
family preparedness and the
need to incorporate one's
functional role into the context of
family and personal concerns.
Explain Explain List Describe
4. Incident Command System
(ICS)

a. Concept of incident command
and incident management, and
how it is applied at the federal,
state, local, agency and
institutional level.
b. Concept and function of an
emergency operations center.
5. Integration with Emergency
Management

a. Processes and lines of
communication in coordinated
multi-agency emergency
response at the local, state and
national level.
Explain Describe Describe List

89

Surgery
and Surgeons
b. Concepts of and contributions
to emergency response
evaluation activities, exercises
and scenario-based events.
Apply quantitive or qualitative
analysis (needs some
rewording and depends by
department)
Describe Describe Describe
c. Social, moral and ethical
challenges that emanate from
disaster planning and response.
Apply quantitive or qualitative
analysis (needs some
rewording and depends by
department)
Describe Describe Describe
6. Communication
a. Risk communication principles
and their application during
disasters.
Explain Describe List Describe
b. Sources to obtain accurate
information during all phases of
a disaster or other emergency
event.
Explain Describe List List
7. Governmental Resources
and Authority

a. State and federal resources
that contribute to emergency
management and response at
the local level e.g. SNS, DMAT,
MMRS
b. Basic legal and regulatory
issues related to emergency
preparedness including those
pertaining to healthcare.
Explain Explain Describe Describe
8. Preparedness Evaluation

90
Surgery
and Surgeons
Contribution of one's profession
to regular emergency response
drills and evaluations as a
means of maintaining expertise
and knowledge.
Explain Explain N/A (No response)

Terrorism II. Terrorism and Public Health
Emergency Preparedness

1. Chemical biologic, radiological and
explosive agents.

a. Knowledge of the major classes of
chemical, biologic, radiological, nuclear and
explosive agents that can be used as terrorist
weapons.
List List Describe Describe
2. Biologic Agents
a. Knowledge of Category A biologic agents,
including epidemiology, routes of exposure,
treatments and infection control principles.
Explain Demonstrate Describe Describe

91

School of
Public
Health
School of Nursing
School of Dental and
Oral Surgery
College of Physicians and
Surgeons
b. Knowledge of Category B biologic agents. Explain List Describe Describe
3. Chemical agents
a. Knowledge of general classes of potential
chemical weapons, including mechanisms of
exposure, decontamination and treatment
principles and concepts of personal
protection.
Explain Demonstrate Describe Describe
4. Radiological Agents
a. Types of radiation associated with potential
terrorist devices, including mechanisms of
distribution, effects of exposure, treatment
and personal protection.
5. Personal Protective Equipment and
Decontamination

a. Basic principles of selection and use of
personal protective equipment appropriate to
a range of situations typical of one's
profession.
Explain Demonstrate Demonstrate Demonstrate

92

School of
Public
Health
School of Nursing
School of Dental and
Oral Surgery
Surgeons
b. Principles and application of
decontamination
(No
Response)
Describe (No Response)

III. Public Health Surveillance and
Response

1. Principles and Practice of Surveillance
a. Principles of surveillance and individual
reporting of potential or actual emergencies
that could affect the health of a community.
Apply Describe List Describe
b. Procedures used to collect patient data for
surveillance or tracking.
Apply Demonstrate Describe List
c. Unusual clinical scenarios that may
represent sentinel cases of victims of an
unannounced use of CBRNE.
Identify Demonstrate Knowledge Demonstrate Describe
2. Interventions
a. Public health interventions that are part of
the response to public health emergencies
such as the use of CBRNE.

93
School of
Dental and
Oral Surgery
Surgeons

IV. Patent Care for Disasters, Terrorism
and Public Heath Emergencies

1. Take medical histories that:
a. determine the absence or presence of
symptoms that are characteristic of exposure
to CBRNE.

Demonstrate

Demonstrate

Demonstrate
b. identify patients who may have
psychological trauma following a CBRNE
event

Demonstrate

Demonstrate

Demonstrate
c. Identify occupational and psychosocial
risks for exposure to potential CBRNE.

Demonstrate

Describe

Describe
d. characterize exposures to potential
CBRNE, including type of agent, timing, and
length of exposure.

Demonstrate

Describe

List
2. Ability to conduct physical exams that:
a. are guided by exposure or potential
exposure to CBRNE.

Demonstrate

Demonstrate
Demonstrate
b. determine the absence or presence of
physical signs that are characteristic of
exposure to CBRNE.

Demonstrate

Demonstrate
Demonstrate
3. Identify patterns of signs and symptoms
likely to be associated with occult
exposure to CBRNE.

Demonstrate

Describe
Demonstrate
4. Interpret results of the medical history,
physical exam, and diagnostic workup to
determine an accurate diagnosis of
CBRNE exposure.

N
O
T

A
P
P
L
I
C
A
B
L
E

Demonstrate

Demonstrate

Demonstrate

94

School of
Dental and
Oral Surgery
Surgeons
5. Incorporate evidence-based diagnostic
procedures and laboratory studies to
confirm the diagnoses and/or causative
agents.

Demonstrate

Demonstrate

Demonstrate
6. Knowledge of signs and symptoms of
acute or delayed critical incident stress
reaction among community members or
responders.

N/A

Describe

Demonstrate
7. Pharmaceutics and pharmaceuticals
used to combat CBRNE e.g., burn
therapies, biochemical antidotes,
antibiotics, vaccines.
Identify (and
describe range of
resources to
address)

Describe

Describe
8. Consider critical aspects of treatment
plans for patients who may have been
affected physically and/or psychologically
by CBRNE including:
Describe and
provide care as
appropriate to
specific
position/role

Demonstrate

a. Acute care management See 8 Demonstrate Demonstrate
b. Long-term management See 8 N/A Describe
c. Secondary and tertiary prevention See 8 N/A List
d. Attention to mental health concerns See 8 N/A Demonstrate
e. Referrals See 8 Demonstrate Demonstrate
f. Awareness of concomitant psychosocial
issues

See 8

Describe
Demonstrate
g. Consultation with public health authorities

N
O
T

A
P
P
L
I
C
A
L
B
E

See 8 N/A Describe

95

School of
Dental and
Oral Surgery
Surgeons
h. The ability to use appropriate precautions
to prevent CBRNE exposure to other patients,
care providers, and themselves (e.g.,
isolation, decontamination, personal
protective equipment, appropriate waste
disposal)

See 8

Demonstrate

Demonstrate
9. Recognize the need for, and to collect
and preserve, forensic evidence from
patients who may be victims of a CBRNE
event.

N
O
T

A
P
P
L
I
C
A
B
L
E

Describe

Demonstrate

Describe

PLACEHOLDER

96
IX. Resources:
Sample Lesson Plan Format

Epidemiology

COMPETENCY: Institute appropriate steps to limit spread, including infection control measures, decontamination
techniques and use of appropriate person protective equipment
SUBCOMPETENCY: Activate infection control measures specific to agent

EPIDEMIOLOGY COURSE OBJECTIVES:

Describe the infectious disease process.
Describe prevention and control interventions to prevent transmission.
Identify infectious diseases, and associated pathogens
Describe their diagnosis, transmission, clinical presentation, prevention and control

METHOD

Lecture
Audio Visual
Computer Assisted
Web-Based Module
Demonstration
Hands-On Learning

97
IX. Resources:
Sample Lesson Plan Format , cont.
CONTENT

Epidemiology of infectious disease process
1. Epidemiologic triangle
Agent
Host
Environment
2. Infectious disease process
Natural history
Exposure
Incubation period
Onset of symptoms/ clinical disease
Recovery, disability, or death
Clinical spectrum of disease
sub clinical
clinical
carriers
3. Characteristics of Microbes
Invasiveness
Pathogenicity
Virulence
Infectious dose
4. Chain of Infection
Agent
bacteria
viruses
fungi (yeasts & molds)
parasites

98
IX. Resources:
Sample Lesson Plan Format, cont.

Reservoir
people
fomites
water
Exit
excretions & secretions
body fluids
respiratory tract
Modes of Transmission
Direct
direct contact
droplet
Indirect
airborne
vehicle
vector
Portal of entry
GI tract
skin
mucous membranes
respiratory tract
Susceptible host
nonspecific defense mechanisms
specific defense mechanisms

99
IX. Resources:
Sample Lesson Plan Format, cont.

5. Infection prevention and control methods
Hand hygiene- just review
Isolation precautions
HICPAC
isolation guidelines
How to read it Recommendations
PPE (INTRODUCE LEVELS OF BT SPECIFIC PROTECTION)
Cleaning/ disinfection/ sterilization
Immunization
Safe work practices

6. Infectious Diseases (Specific to include WMD)
AGENT
Organism
Transmission
Clinical presentation
Diagnosis
Prevention & control
Post exposure management

EVALUATION
Written Exam
Pre-Test
Post-Test
Verbalization
Return- Demonstration
PLACEHOLDER

100
IX. Resources:
BIBLIOGRAPHY

1. Public Health Emergency Response Guide for state, local, & tribal public health directors- Dept. of Health and
Human Services- CDC and Prevention; available at: http://www.bt.cdc.gov/planning/responseguide.asp Accessed
J une 2006.

2. BT & Emergency Readiness Competencies for all PH workers- Public Health Ready, Columbia and NACCHO,
Columbia University School of Nursing Center for Health Policy, CDC and Prevention/Association of Teachers and
Preventive Medicine Agreement #TS0740- November 2002; available at:
http://www.nursing.hs.columbia.edu/institutes-centers/chphsr/btcomps.html Accessed J une 2006.

3. Instructions for use of Emergency Preparedness core competencies for all public health workers training program -
Columbia University-Center for Public Health Preparedness(CPHP); available at:
http://www.ncdp.mailman.columbia.edu/program_cphp.htm Accessed J une 2006.

4. Generic: Basic Emergency Preparedness Competency Training Program -Sample pre and post test questions for
measuring achievement of emergency preparedness learning objectives- CPHP, available at:
http://www.ncdp.mailman.columbia.edu/program_cphp.htm Accessed J une 2006.

5. Core Public Health Worker Competencies for Emergency Preparedness and Response -Local Public Health
Competency for Emergency Response- Columbia University- School of Nursing Center for Health Policy, April
2001; available at: http://www.cumc.columbia.edu/dept/nursing/research/ResCenters/chphsr/index.html Accessed
J une 2006.

6. Oswego An Outbreak of Gastrointestinal Illness Following a Church Supper, Instructors Guide - CDC and
Prevention- Epidemiology program office case studies in applied Epidemiology No. 401-403.

7. Compendium of acute food borne and waterborne diseases - CDC, Epidemiology Program Office; 2003.

101
IX. Resources:
BIBLIOGRAPHY, cont.

8. Suspected Legionnaires disease in Bogalusa- Instructors Guide, Students Guide - CDC- Epidemiology Program
Office- Case studies in applied Epidemiology No. 912-303- Dept of Health and Human Services/EIS 2003.

9. Texarkana -Epidemic Measles in a Divided City-Instructor's Guide - CDC and Prevention, Epidemiology program
office, Case studies in applied Epidemiology No. 711-903- US Dept of Health and Human Services/EIS, 2003.

10. Paralytic Illness in Ababo- Instructors Guide -CDC and Prevention Epidemiology Program office, case studies in
applied Epidemiology- No. 891-903- Dept. of Health and Human Services/EIS 2003.

11. An Epidemic of Thyrotoxicosis- Instructors Guide - CDC and Prevention Epidemiology Program office, case
studies in applied Epidemiology No. 873-903-Dept. of Health and Human Services/EIS 2003.

12. Homeland Insecurity: Building expertise to Defend America from Bioterrorism - Partnership for public service;
available at http://www.ourpublicservice.org Accessed J une 2006.

13. Principles of Epidemiology Second Edition An Introduction to Applied Epidemiology & Biostatistics - US Dept of
Health and Human Services, CDC and Prevention, December 1992.

14. Terrorist CBRN Materials & Effects - Central Intelligence Agency- May 2003.

15. Compendium of Federal Terrorism Training For State & Local Audiences - Central Intelligence Agency, J une 10,
2004.

16. Criminal and Epidemiological Investigation Handbook - 1. U.S. Dept. of J ustice, 2. Federal
Bureau of Investigation, 3. U.S. Army Soldier Biological chemical command; 2003.

17. Office For Domestic Preparedness Guidelines For Homeland Security: Prevention & Deterrence - U.S. Dept of
//////Homeland Security J une 2003.

102
IX. Resources:
BIBLIOGRAPHY, cont.
18. Homeland Security Exercise & Evaluation Program Vol I: Overview & Doctrine - U.S. Dept. of Homeland Security,
Office for Domestic Preparedness, May 2004.

19. Homeland Security Exercise & Evaluation Program Vol II: Exercise Evaluation & Improvement - U.S. Dept. of
Homeland Security, Office for Domestic Preparedness; October 2003.

20. Homeland Security Exercise and Evaluation Program Volume III: Exercise Program Management and Exercise
Planning Process - U.S. Dept of Homeland Security, Office for Domestic Preparedness; J uly 2004.

21 ODP WMD Training Program Enhancing State and Local Capabilities to Respond to Incidents of Terrorism - Dept.
of Homeland Security, Office for Preparedness; October 2004.

22. Fire and Emergency Services Preparedness Guide for the Homeland Security Advisory System First Edition
Federal Emergency Management Association (FEMA); J anuary 2004.

23. Vulnerability Assessment Methodologies Report - U.S. Dept. of Homeland Security, Phase I Final Report, Office for
Preparedness; J uly 2003.

24. Guidance for Water Utility Response, Recovery and Remediation actions for man-made and/or technological
emergencies - Environmental Protection Agency, Office of Water April 2002. Available at: www.epa.gov/safewater
Accessed J une 2006.

25. Emergency Responder Guidelines(29)- Office of J ustice Programs Office for Domestic Preparedness; August
2002, available at: http://www.ojp.usdoj.gov/odp Accessed J une 2006.

26. National Response Plan - U.S. Dept. of Homeland Security; December 2004.

27. GIS for Homeland Security - ESRI 2001.

103
IX. Resources:
BIBLIOGRAPHY, cont.

28. Bioterrorism Readiness Plan: A Template for Healthcare Facilities, APIC Bioterrorism Task
Force - CDC Hospital Infections Program Bioterrorism Working Group; April 13, 1999.

29. Second Edition Medical Management of Radiological Casualties Handbook - Military Medical Operations Armed
//////Forces Radiobiology Research Institute Bethesda, Maryland 208895603; April, 2003; available at:
//////http://www.afrri.usuhs.mil.

30. Dept of Homeland Security Working Group on Radiological Dispersal Device (RDD)
/Preparedness Medical Preparedness & response Sub-Group - Dept. Of Veteran Affairs, Dept.
/Of Health and Human Services; May 1, 2003.

31. Managing Hazardous Materials Incidents- A Planning Guide for the Management of
Contaminated Patients - A three volume series, Agency for Toxic Substances and Disease Registry; March 2001.

32. National Strategy for Combating Terrorism - U.S. Dept. of Homeland Security; February 2003.

33. National Incident Management System - U.S. Dept. of Homeland Security, available at: http://www.nimsonline.com
////// /Accessed J une 2006.

34. Aid for Decontamination of Fire and Rescue Service Protective Clothing and Equipment After Chemical, Biological,
////////and Radiological Exposures - Lawson, J . Randall, J arboe, Theodore L. National Institutes of Standards and
///////Technology(NIST) Special Publication 981, US Dept of Commerce, May 2002.

35. Homeland Security Preparedness Technical Assistance Program (HSPTAP) - Technical Assistance Catalog- U.S.
///////Dept. of Homeland Security.

36. Terrorism with Ionizing Radiation General Guidance Pocket Guide - Produced by the Employee Education System
////////or the Office of Public Health and Environmental Hazards, Department of Veterans Affairs; August 2003.

104

IX. Resources:
BIBLIOGRAPHY, cont.

37. Interim Recommendations for Firefighters and Other First Responders for the Selection & Use of Protective
///////////Clothing and Respirators against Biological Agents(43)- U.S. Dept. of Health and Human Services, CDC.

38. What Every Public Safety Officer Should Know About Radiation & Radioactive Materials National Law
///////Enforcement and Corrective Technology Center, National Institute of J ustice; available at http://www.justnet.org.

39. Radiological Emergency Management - Independent Study Course FEMA.

40. Smallpox Clinical Poster - Dept. of Health and Human Services, Center for Disease Control and Prevention.

41. Terrorist Organization Reference Guide - U.S. Dept. of Homeland Security, U.S. Customs and Border Protection,
/////////Office of Border Patrol.

42. WHO Building Capacities for Risk Reduction - Disaster Management Training Programme,1997.

43. DHS WMD Awareness Course - U.S. Dept. of Homeland Security, Office for Domestic Preparedness, Center for
/////////Domestic Preparedness.

44. Hospital Provider Course- Defense against WMD)- Office for Domestic Preparedness.

45. Natl Incident Management System Overview - U.S. Dept. of Homeland Security, National Incident
/////////Management System, Integration Center.

46. CDC Anthrax - Center for Disease Control and Prevention; available at: http://www.bt.gov Accessed J une 2006.

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Competencies to Curriculum in the Context of Preparedness

Friday, September 22, 2006

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