A competency-based tuberculosis curriculum that includes required knowledge, attitudes and skills will be development and implemented at all levels of education for medical students, post-graduate physicians in training and community-based practicing physicians. A Community Advisory Board will be formed and charged with the task of providing advice to the Key Grant Personnel in the design of a curriculum that addresses community needs. The curriculum will use conventional and innovative teaching methods. For example, after being introduced by means of a video to tuberculosis risk assessment and the proper method o administration and reading of a tuberculin skin test, the first year students shall tuberculin skin test each other, under supervision, and the results recorded in their health records. Teaching OSCEs will be developed for the second year, which will incorporate written clinical cases that highlight problems appropriate for the particular course, i.e., microbiology, pathology, chemotherapy, etc. Third year students will be assigned during the Medicine rotation (20 students at a time) to community-based programs for patient tuberculin testing, education and counseling. In conjunction with this assignment, the third year medical students will take part in a 4-hour workshop on communication and negotiation skills with use of role playing and simulated patients. For fourth year students and residents, a group of professional actors will perform improvisational vignettes that emphasize the unique ethnic, cultural, socioeconomic and medical dimensions of tuberculosis. The same situation will be presented from multiple perspectives, i.e., the patient's, the family's and the physician's point of view. The emotional and attitudinal responses of the audience to the dramatic presentation will serve as a catalyst for a discussion that follows the performance. An educational program for community-based physicians in the Philadelphia Department of Public Health's Tuberculosis Control Program will be developed in the form of workshops with teaching OSCEs, communication and negotiation skills training, and dramatic performances. A Faculty Development Program will train the faculty to implement the competency-based tuberculosis curriculum. Periodic symposia with the Medical College of Pennsylvania (MCP), Philadelphia County Medical Society, Department of Public Health and existing community-based programs in the Philadelphia region will update health professionals on the progress of regional and national tuberculosis control. Formative and summative evaluations will be conducted each year. The tuberculosis curriculum developed at MCP will be shared with other recipients of the Tuberculosis Academic Award for their review and criticism. We would anticipate that the resulting revised tuberculosis curriculum developed and implemented at MCP will serve as a model to be replicated at other institutions.
