Medical Student Education on Immunizations

Transcription

1 Medical Student Education on Immunizations Designing and implementing a flipped classroom, case-based curriculum Allison Coleman, MS3 Deborah Lehman, MD

2 Target Population Medical Students, clerkship training Surveyed regarding vaccine knowledge, attitudes, sources used

3 Further surveyed Implemented curriculum and surveyed throughout year Outside of school (conversations with family or friends), I have encountered vaccine hesitancy In my clinical work this year, I have encountered vaccine hesitancy

4 Survey Results- Knowledge Pertussis is more likely to cause serious complications in an adult rather than in a child. A 9-month-old has not received any vaccines since her 2 month visit. All vaccine series should be restarted Some vaccines are contraindicated in a 6-month-old with a seizure disorder An 18-month-old with upper respiratory infection symptoms and low grade fever should have vaccines postponed Answered Correctly Unsure Answered incorrectly

5 Survey Results- Attitudes There should be immunization requirements for children entering kindergarten. There should be an exception to immunization requirements for religious beliefs There should be an exception to immunization requirements for personal beliefs. Annual influenza vaccines should be mandated for health care workers Strongly Agree Agree Undecided Disagree Strongly Disagree

6 Survey Results- Attitudes There are no vaccine-preventable diseases (e.g. Chicken Pox, Measles, etc.) for which natural infection is preferred over vaccination. Alternate or delayed vaccine schedules to spread vaccinations over the first two years of life are as safe and effective as the CDC schedule. The recommended vaccination schedule exposes infants and children to too much of an immunologic burden in a single visit. The recommended vaccination schedule requires that infants and children receive too many injections in a single visit Strongly Agree Agree Undecided Disagree Strongly Disagree

7 Survey Results- Influences Medical School Curriculum Attendings and Professors Stories in Popular Media Electronic Information Databases Peers Personal Observation Peer-Reviewed Articles Textbooks Patient Education Handouts Google Influences on Knowledge Influences on Attitudes

8 Educational Objectives Recommend vaccines based on age, vaccination history Understand, justify, explain importance of vaccines and be knowledgeable about VPDs Find and use reliable resources Recognize common parental concerns, defend the value of vaccines with unique, evidence-based responses

9 Overview of Curriculum Prepare for class ahead of time Watch Video Small group discussions Assigned 1 of 4 cases Given list of resources Groups present conclusions Discussion with faculty guidance Large Group Discussion

10 Video Overview Vaccine preventable diseases Types of vaccines Safety of vaccines Current schedule True contraindications Vaccine concerns Addressing concerns Trustworthy resources

11 Images are in the public domain: rch.asp. Image IDs, clockwise from top left: 6121, 713, 12785, 1335, 6373, 1992, 5578

12 Impact on Measles, Mumps, and Rubella Rubella and CRS United States Measles United States Mumps United States Centers for Disease Control and Prevention. MMWR 2013;62

13 In Class Resources Handout suggesting trusted websites and apps CDC Immunization Schedule List of cases with specific questions

14 Case 1: Liam 12-month-old Which vaccines? Risks of these diseases? Concern about toxins in vaccines Risk of seizures in neurologically susceptible individual? Immunocompromised household member Baby walking (c) Philippe Put, CC BY 2.0

15 Case 2: Emily 7-week-old Which vaccines? What combinations can be used? No need for vaccines as everyone around infant is healthy Preference for natural immunity, risk of wild type diseases Most important vaccines? Newborn Noa. (c) Mario Antonio Pena Zapatería, uc CC BY-SA 2.0

16 Case 3: Clara 8-month-old Restart vaccine series? OK to give if mild URI? Fussy after last vaccines- what reactions are dangerous/contraindication? Overwhelming immune system Alternative Schedule Influenza vaccine Reese Crawling on the Deck. (c) Donnie Ray Jones, LP CC BY-SA 2.0

17 Case 4: Santiago 11-year-old Vaccines up to date as of WCC at age 9 Which vaccines? Acute care visit- give vaccines? HPV vaccine when not yet at risk? Side effects of vaccines When to complete series? Me sitting down. (c) Limeabeans, /8DLefJ CC BY-SA 2.0

18 Group work

19 Student Response Clinically relevant- you won t find this in First Aid! The podcast was very good, but the case-based approach was a bit slow. Good questions related to cases. Good opportunity for group work. This was wonderful! Love the cases! Would also love a list of articles to read about these topics.

20 Future Directions Expand to pediatric residents? Expand to pre-clerkship years? Expand to nursing students? Publish to share more widely?

21 Summary Successful implementation Positive feedback Goal to strongly recommend vaccines Engage families in discussion Opportunities for expansion