After years of a declining incidence of tuberculosis (TB), the past several years have seen a dramatic increase in the number of cases of active tuberculosis diagnosed in New York City. In 1992, there were 3811 reported cases of tuberculosis cases in New York; this number represented a 152% increase from 1980. The current incidence rate for tuberculosis in New York City is 52' 100,000, compared to the incidence of roughly 10/I00,000 for the United States as a whole. In New York, the distribution of tuberculosis among various ethnic and racial groups is as follows: 57% of patients are Africans-Americans, 27% are Hispanic, and 10% are Asian. New York City accounts for 14.3% of all cases of tuberculosis in the United States, and Bellevue Hospital last year cared for more tuberculosis patients than any other hospital in New York City. Also, as a significant percentage of cases at Bellevue are due to multi-drug resistant (MDR) TB, Bellevue is in many ways is at the epicenter of the current TB epidemic in the United States. In view of this crisis in tuberculosis, we have developed a series of educational initiatives designed for medical students, houseofficers, fellows, primary care physicians, and subspecialists designed to promote awareness and improve care of patients with tuberculosis. A synopsis of the specific aims follows: Coordinate and improve the teaching of tuberculosis in the four years of the medical school curriculum. In the first year, the microbiology course will be updated to include recent developments in the cellular and molecular biology of mycobacteria. In the second year there will be more emphasis on the clinical and epidemiological aspects of TB, and several self-study computer based learning modules will be developed. The third year mandatory ambulatory care rotation will be expanded to include the outpatient Directly Observed Therapy (DOT) program. A fourth year elective in tuberculosis will be offered by the Bellevue Chest Service. Strengthen training in tuberculosis for pulmonary fellows and medical housestaff at Bellevue Hospital/NYU Medical Center. We will develop a computerized teaching file which will allow fellows and housestaff to become expert in recognizing the myriad radiographic features, both by plain film and CAT scan, of TB. We will create a computerized data base to track TB patients seen on the Bellevue Chest Service each year. Specific curriculum objectives will be developed for fellows and residents on the Chest Service. Develop programs of community outreach to reach a wide audience of practicing physicians beyond Bellevue Hospital/NYU Medical Center. In conjunction with the New York Lung Association, we will develop a newsletter of recent developments of clinical importance in TB care, and we will develop a Speakers Bureau for continuing medical education in the greater New York area. With the NYC Department of Health, we will provide educational programs for physicians working in city clinics.
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