I propose to enhance the level of knowledge about tuberculosis (TB) beginning with medical students and housestaff and extending to community physicians with no medical school or hospital affiliation. The education efforts must extend to nurses and eventually to the general public in the community. Our community includes Washington Heights, which is primarily comprised of immigrants, both legal and illegal, from the Dominican Republic, Mexico and other South American countries in which TB is endemic, and Central Harlem, which is primarily African American. Poverty, drug abuse and homelessness have contributed to the inherently high rate of TB to create the highest case rates in the country and enormous obstacles to effective treatment. Over the past several decades, TB has been reduced to a negligible level in the medical school curriculum. The curriculum at Columbia University College of Physicians and Surgeons is currently being revised, and l propose to institute specific TB instruction appropriate to each level of medical school training. First year students will learn about the social and psychological barriers to treatment through direct involvement with one patient throughout the year; second year students will have additional pharmacology, immunology and laboratory sessions to incorporate second line TB drugs the interaction between HlV and TB, and culture and sensitivity testing; third year students will participate in detailed case conference discussions of one or two TB patients per medicine rotation; and fourth year students may chose a month long elective in the Bureau of TB clinic next door to the Presbyterian Hospital (PH). Community physicians will participate in a preceptorship at PH with formal didactic sessions and direct observation of patient care in the TB clinics while those physicians working in community clinics will have on site teaching in the form of monthly case conferences as well as regular lectures. All community physicians will learn about the expanded role of the Department of Health Bureau of TB in order to be directly integrated into the TB control system. Nurses, the increasingly important front line health care providers to TB patients, will receive formal instruction and ongoing regular specific patient reviews in a didactic manner. Finally, a pilot project will be established to provide general public education in the community with the ultimate goal of soliciting outside funding and support if successful.
