Medical residents unclear about TB guidelines

US medical residents are not proficient at diagnosing and managing tuberculosis (TB), according to a report published in the online open access journal, BMC Infectious Diseases.

Dr. Petros Karakousis et al. from the Johns Hopkins University School of Medicine, US, administered a twenty-question survey about TB to 131 medical residents attending a single teaching conference at each of their respective institutions in 2005. The residents came from four different urban medical centers in Baltimore and Philadelphia, which both have a moderate prevalence of TB.

Just under half of the questions were answered incorrectly. The section on the diagnosis and treatment of latent TB (where a patient is infected with TB but has no symptoms) was particularly poorly answered, with residents getting on average three-fifths of the answers wrong. The residents also had particular difficulty in answering questions pertaining to the risk of progression from latent TB to active disease (where a patient develops TB-related symptoms), as well as those involving interpretation of diagnostic tests for patients with active TB. As physicians training at urban medical centers are likely to be the first point of contact for patients with previously undiagnosed TB, it is important that they are properly trained in spotting and treating this infectious disease.

"We cannot be sure that lack of tuberculosis knowledge leads to poor management of patients," says Karakousis. "Although trainees may score poorly, they may be quick to consult experts in Infection Control, Infectious Diseases, or Pulmonary Medicine to assist in diagnosis, isolation, and treatment." However, the authors conclude that residents, knowledge gaps may have important implications for public health.

TB cases in the US fell to a historic low of 13,767 in 2006. However, there are an estimated 10 to 15 million persons in the United States with latent TB infection, who are at risk for developing active TB. Social factors, including homelessness, drug use, incarceration, and immigration, as well as HIV infection, have contributed to high TB prevalence in urban areas in the US.