Implementation of environmental recovery training response to biological incidents in a human health degree

Agents involved in biological incidents and outbreaks of infection can spread easily, so response teams are required to quickly implement a recovery plan to decontaminate and restore the environment impacted by these incidents to minimise public risks. A group of academics at De Montfort University (DMU, UK), with support from first responders during the 2014-16 Ebola outbreak, are developing appropriate training to provide basic skills so human health science students can respond to biological incidents. Following the competences identified by the European Commission, we have created key competences for these students based on the core skills that any medical first responder to biological emergencies should have. To provide students with the key competences related to environmental planning, we have created specific training that consisted of a 2 hours practical plus theory related to emerging diseases and the international response provided to tackle the Ebola pandemic. The practical component was a research-led workshop to develop a complete protection and recovery plan to respond to an outbreak of infection by Cyclospora cayetanensis in an urban area. Students used the novel methodology developed by Public Health England [“UK Recovery Handbook for Biological Incidents” (Pottage et al., 2015)] [1] to select appropriate options or techniques to protect and recover the affected environment, according to the physiological characteristics of the biological agent/microorganism involved and the environment impacted. Critical thinking and discussion is also needed to select recovery options (R.O.), e.g. use of chlorine-based decontamination liquids as part of the R.O. “reactive liquids” will have limited efficacy as oocysts of Cyclospora are resistant to these. After successful testing of the training with postgraduate students, we introduced it in a level 6 module in the DMU degree programme BMedSci in Medical Science in 2016/17 (n=24). A small proportion of these BMedSci students reported that they did not enjoy (13.4%) or were not satisfied (20%) with the training provided, which could be attributed to the fact that the topic of the training (environmental sciences) was not of direct interest for these students who are studying a degree more related to medicine. However, despite the short duration of the training, students were able to tailor an appropriate response with the resources and information provided (physiological characteristics and a literature review on decontamination/inactivation techniques for Cyclospora was provided to overcome time constraints). Specifically, 73.3% indicated that they gained some public health prevention/preparedness knowledge against a biological incident; 80% highlighted that they learnt how to establish some public health interventions; and 60% learnt how to tailor a recovery plan. A few students (20%) had difficulties with the recovery concepts and the interpretation of the physiological characteristics, which may be attributed to limited background knowledge of microbiology and parasitology (as the BMedSci programme does not have a complete module dedicated to the study of these topics). In conclusion, the increased prevalence of biological contamination incidents necessitates development of appropriate training to include environmental decontamination strategies to protect human health. The short teaching intervention described in this paper could be used to easily address this necessity

Results on a pedagogic approach for tailoring public health interventions to minimise opportunistic infections.

We are performing curriculum modifications on the first year BSc (Hons) Biomedical Science module “Basic Microbiology” (De Montfort University, UK) to increase students’ knowledge of basic medical parasitology and infectious diseases, so these students can acquire the necessary skills to tackle their final degree module “Medical Microbiology”. Following student feedback on a novel short intervention in 2017/18 to promote awareness about human immunodeficiency virus (HIV), we have created an engaging workshop session to cover not only HIV but also the opportunistic infections that can affect HIV patients that have developed acquired immune deficiency syndrome (AIDS) and how to prevent them. The objective of this work was to evaluate the effectiveness of the improved workshop developed and to collect students’ impressions to perform further modifications if needed. Briefly, students were required to develop public health measures for HIV positive patients with two different degrees of immunosuppression (i.e. with CD4+ T cells in peripheral blood above and below 200 cells/μl) to prevent exposure and infection from opportunistic pathogens such as Cryptosporidium spp., Toxoplasma gondii or Pneumocystis jirovecii from: a) sexual exposures; b) intravenous drug use; b) environment and work; c) food and water; d) foreign travel. Students, following evidence-based public health methodology, tailored their measures or interventions using the most up-to-date information reported in the literature regarding HIV chemoprophylaxis and recent guidelines published by US Department of Health and Human Services on HIV/AIDS treatment and prevention. Interventions were critically analysed with all students in the last 20 min. of the workshop, which was repeated several times due to the number of students (n=203). The objectives of this workshop were evaluated by careful analysis of a specific feedback questionnaire (n=46 out of 203) voluntarily completed by students at the end of the workshop. The questionnaire showed the following feedback: 80.4% (65.2% agreed; 15.2% strongly agreed) indicated that they learnt how to identify public health interventions; and 95.7% (56.5% agreed; 39.1% strongly agreed) indicated that they would be able to establish measures to reduce HIV transmission and prevent opportunistic infections. Additionally, 95.7% (39.1% agreed; 56.5% strongly agreed) indicated that the workshop helped them to understand the relevance of local and global interventions. Finally, 97.8% of responders considered that the content (52.2% agreed; 45.7% strongly agreed) and duration (60.9% agreed; 37% strongly agreed) of the workshop was appropriate; and 89.1% (58.7% agreed; 30.4% strongly agreed) and 73.9% (41.3% agreed; 32.6% strongly agreed) enjoyed and were satisfied with the workshop provided, respectively. In conclusion, the improved workshop developed would seem to be effective for promoting sexual and public health education to minimise opportunistic pathogen infections in relevant patients when delivered to students with a basic knowledge of microbiology and parasitology

Focus group to create a virtual case study model unit for the DMU e-Parasitology.

De Montfort University (DMU, Leicester, UK) is leading a teaching innovation project for the creation of a complete package for teaching and learning human parasitology in collaboration with the Spanish universities: San Pablo CEU and Miguel Hernández, and practicing Biomedical Scientists from the UK National Health Service. The DMU e-Parasitology package will be freely available on the DMU website (http://parasitology.dmu.ac.uk/) late in 2018 and present three modules: a theoretical unit for the study of medical parasitic diseases; a virtual laboratory and microscope sections with a complete collection of clinical slides for the study of these major diseases. To provide the user of this novel package with a holistic and complete experience for the learning of medical parasitology we have started the development of a fourth section, which will hold highly interactive virtual case studies in which the user will be provided with a medical history and different clinical slides to identify the parasites and their structures. The user will need to reflect and critically think to suggest potential diagnoses, additional diagnostic techniques, treatment and prevention techniques for that parasitic disease. A first virtual case study has been created in the DMU e-Parasitology here: http://parasitology.dmu.ac.uk/learn/case_studies/cs1/story_html5.html, as described in Peña-Fernández et al. (2018) [1]. The degree of difficulty is medium-high, so a background in parasitology is needed to resolve it. Comprehensive student feedback is being collected to improve this case study, which will be used as a model unit to develop future case studies for this section. To determine the feasibility of this case study to train postgraduate students, DMU students attending the MSc Advanced Biomedical Science have completed the case study during a workshop session specially delivered this academic course 2017/18 (n=9). We collected the following results: 100% students indicated that the eParasitology is interactive (71.4% agreed, 28.57 strongly agreed), and the case-study presented was appropriate for their studies (57.1% agreed, 42.9% strongly agreed). In relation to the content, all students highlighted that it was relevant for their studies (42.9% agreed, 57.1% strongly agreed), and indicated that the exercises presented were easy to understand (71.43% agreed, 28.57% strongly agreed). In the free-open questions available in the questionnaire, postgraduate students demanded more case studies and mini-formative assessments within the theoretical units that they reviewed to answer the virtual case study (free-living amoebas and Entamoeba histolytica). Finally, they suggested the provision of the correct answers throughout the case study instead of at the end

Novel methods for teaching biological incident response at De Montfort University.

Human health professionals were critical responders to the unprecedented 2014-16 Ebola crisis in West Africa, highlighting the relevance of biological incident response training. A group of academics at De Montfort University and EU first responders have designed basic training for undergraduate human health science students to respond to these events. We also developed basic competences specifically designed for these students that encompass those identified by the European Commission to tackle CBRN events. The novel training developed is effective in facilitating the acquisition of the developed competences by health science students and the necessary skills to respond to minor biological events

Virtual libraries of tissue and clinical samples: potential role of a 3-D microscope.

Our international innovative teaching group from different European Universities (De Montfort University, DMU, UK; and the Spanish University of Alcalá, University Miguel Hernández and University of San Pablo CEU), in conjunction with practicing biomedical scientists in the National Health Service (UK) and biomedical researchers, are developing two complete e-learning packages for teaching and learning medical parasitology, named DMU e-Parasitology (accessible at: http://parasitology.dmu.ac.uk), and biology and chemistry, named DMU e-Biology (accessible at: http://parasitology.dmu.ac.uk/ebiology/index.htm), respectively. Both packages will include a virtual microscope with a complete library of digitised tissue images, clinical slides and cell culture slides/mini-videos for enhancing the teaching and learning of a myriad of techniques applicable to health science undergraduate and postgraduate students. Thus, these packages include detecting human parasites, by becoming familiar with their infective structures and/or organs (e.g. eggs, cysts) and/or explore pathogenic tissues stained with traditional (e.g. haematoxylin & eosin) or more modern (e.g. immunohistochemistry) techniques. The Virtual Microscope (VM) module in the DMU e-Parasitology package is almost completed (accessible at: http://parasitology.dmu.ac.uk/learn/microscope.htm) and contains a section for the three major groups of human-pathogenic parasites (Peña-Fernández et al., 2018) [1]. Digitised slides are provided with the functionality of a microscope by using the gadget Zoomify®, and we consider that they can enhance learning, as previous studies reported in the literature have reported similar sensitivity and specificity rates for identification of parasites for both digitised and real slides. The DMU e-Biology’s VM, currently in development, will provide healthy and pathological tissue samples from a range of mammalian tissues and organs. This communication will provide a description of both virtual libraries and the process of developing them. In conjunction, we will use a three-dimensional (3D) super-resolution microscopy, 3D Cell Explorer (Nanolive, Lausanne, Switzerland), to incorporate potential 3D microscopic photographs/short videos of cells to provide students with information about the spatial arrangement and morphologies of cells that are essential for life

Teaching intervention to enhance HIV infection awareness in a biomedical science degree

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.Condom use remains the predominant prophylactic intervention to control rates of human immunodeficiency virus (HIV) infection. However, chemoprophylactic strategies, which involve pre-exposure prophyaxis (PrEP) and post-exposure prophyaxis (PEP), have emerged as appropriate prevention tools to minimise and prevent future infections. Different studies have indicated that PrEP can prevent new HIV infections among men who have sex with men when used daily or event-based, and it is also effective with heterosexuals and people who inject drugs. However, appropriate education is needed as recent reports have observed a decline in adherence to PrEP over time, particularly in young adults, which will impact on the effectiveness of PrEP. Thus, we created a brief educational short intervention (3 hours) to increase the awareness of HIV with second year BMedSci Medical Science (Hons) students at De Montfort University (DMU, UK) in 2016/17 (Peña-Fernández et al., 2017). Briefly, BMedSci students tailored a community-centred intervention programme to reduce HIV infection rates following evidence-based public health methodology. 92% indicated an acquisition of knowledge for preventing HIV transmission and tools to fight this disease. However, BMedSci students also showed a lack of knowledge of preventative measures (PrEP and PEP), routes of transmission and appropriate screening. We implemented a similar teaching strategy with BSc Biomedical Science (BMS) students enrolled in the level 4 module of Basic Microbiology in 2017/18, but limited to two hours: one-hour lecture and one hour workshop in which different HIV prevention strategies were discussed and analysed by students. BMS students were also provided with an overview about the Joint United Nations Programme on HIV/AIDS (UNAIDS) 90:90:90 targets in the UK (2016). In a similar way as with the BMedSci cohort, BMS students showed little awareness about PEP/PrEP, specifically knowledge about what are they/how they work, access and usage. This teaching intervention was well-received by students according to the feedback provided in the final module level feedback. BMS participants (n=27 out of 187 students) indicated that they enjoyed the session and suggested a practical session and the introduction of case studies to enhance the teaching intervention. We are developing a virtual clinical case study on HIV following recent successful experiences in the development and introduction of these novel learning strategies and have performed small modifications in the delivery of this workshop for 2018/19 to increase engagement and interaction. In conclusion, we consider that similar short education interventions that specifically target HIV chemoprophylaxis would be needed in any degree to prevent the decline in adherence to PrEP over time observed in young adults and reduce PEP/PrEP stigma and other barriers which could impede their access

Importance of teaching environmental contamination and decontamination in human health science degrees

The file attached to this record is the author's final peer reviewed version.A novel short training in environmental toxicology, risk assessment and decontamination was created in the specialty of “Industrial Pharmacy and Galenic” at the University of Alcalá (UAH, Spain) in 2013-14 to provide postgraduate pharmacists with basic skills, tools and knowledge to decontaminate environments affected by chemical accidents. These students completed a highly specialised research-led workshop (training) to decontaminate an open water system affected by a chemical industry spill accident using the “UK Recovery Handbook for Chemical Incidents” (UKRHCI; Wyke-Sanders et al., 2012). The UKRHCI has been developed by Public Health England (PHE) and includes an innovative methodology to select appropriate decontamination options and techniques to tackle environments impacted by chemicals. This training was modified in 2015/16 to introduce the innovative PHE virtual resource “Chemical Recovery Navigation Tool” (CRNT; published in 2015) that follows the same methodology and resources described in the UKRHCI. Comprehensive students’ feedback, including a SWOT analysis (weaknesses, threats, strengths and opportunities), was collected to investigate the implemented changes in our training. The modifications undertaken raised high levels of student satisfaction. Briefly: 100% students reported that the CRNT facilitated the understanding of the training and the selection of recovery options to respond to the case scenario proposed. Students described as strength that the workshop was very interesting, interactive and novel, and its execution in English (as the training was delivered at the Spanish university UAH). The possibility of working in environmental toxicology and decontamination was described as an opportunity. Students highlighted as weaknesses and threats its low relation with the pharmaceutical industry and brief duration (5 hours). This academic course (2016/17), a comprehensive modification has been undertaken at De Montfort University (DMU, UK) to adapt this novel training to a range of different human health science programmes, including master’s students attending the MSc. Advanced Biomedical Science programme at DMU and undergraduate Pharmacy students at the University of San Pablo CEU (USP-CEU, Spain). An Erasmus+ mobility grant for academics was satisfactorily used to validate this short training at USP-CEU earlier in 2017. A specific feedback-questionnaire distributed in both academic arenas have provided the following results: 85.7% (USP-CEU) and 50% (50% neither agree nor disagree; DMU) of students enjoyed the workshop provided. 83% of the master’s students (DMU) and 100% of undergraduate students (USP-CEU) reported that they learnt how to select appropriate recovery options to decontaminate the open water and urban environments proposed. Finally, 42.9% (57.1% neither agree nor disagree) and 83% of students have recommended the incorporation of more similar training in each programme respectively (USP-CEU and DMU). The short training described in this paper have shown to be effective in improving students’ knowledge and skills to restore environments impacted by chemical agents. We consider that all human health undergraduate programmes should teach some topics on environmental toxicology and decontamination due to the increasing use of toxic and carcinogenic chemicals by people and industries around the world

Public Health England's recovery tools: potential teaching resources?

The file attached to this record is the author's final peer reviewed version.Training to combat chemical and radiation accidents, incidents or attacks is critical for health professionals due to recent events involving these hazards or their use as unconventional weapons, such as the use of the nerve agent novichok in Salisbury, UK. Health professionals need to have appropriate knowledge and skills to effectively respond to future events involving any of these substances, which requires a rapid and coordinated response from different professionals to protect the environment and minimise the number of people exposed and reduce morbidity and mortality. However, despite chemical and radiation incidents becoming increasingly prevalent, literature reviews have shown that there is a lack of teaching of appropriate competences to face future crises in Europe, particularly amongst clinicians and other health professionals that would be part of the initial response. Thus, De Montfort University (DMU, UK) in collaboration with different academics from the University of Alcalá (Spain) and researchers from Public Health England (PHE) with comprehensive experience in environmental decontamination and restoration, have created a short training course for providing undergraduate/postgraduate students with basic skills to respond to chemical incidents, basic skills that are based on the major competences recently identified by the European Commission [1]. This novel training has been tested with students from different backgrounds in various European universities, recording high degrees of acquisition of the various basic competences that we developed to initially respond to chemical events [2]. To develop the practical part of this chemical training, we have incorporated the novel guidance and methodology developed by PHE to successfully tailor a protection and recovery response to any incident involving chemical substances, which is available in the “UK Recovery Handbook for Chemical Incidents” [3] and its web-based tools: “Chemical Recovery Navigation Tool” (CRNT, [4]) and “Chemical Recovery Record Form” (CRRF, [5]). These innovative resources aid the user to select effective protection, decontamination and restoration techniques or strategies from a pool of up-to-date options applicable to different environments according to the physicochemical properties of the chemical(s) involved and the area affected. The CRNT is accompanied by the CRRF, which facilitates collection and analysis of the necessary data to inform decisions, and an e-learning resource named “Chemical Recovery: Background” (CRB, [6]), which could facilitate the learning of environmental decontamination and restoration. We are currently developing a short training course to cover minor radiation incidents; this radiation training will follow the same methods used to develop the chemical training, but with the specific PHE recovery tools to tackle such events, specifically the “UK Recovery Handbooks for Radiation Incidents” [7] and its associated web-based tools “Radiation Recovery Navigation Tool” (Rad RNT, [8]), one for each environment: food production systems, inhabited areas and drinking water supplies. This communication will explore the use of the PHE’s Recovery Navigation Tools as potential resources to facilitate the acquisition of basic knowledge to tailor protection and recovery interventions for minor chemical and radiation incidents to protect the public

Teaching medical parasitology in a new Physician Associate master’s programme.

The file attached to this record is the author's final peer reviewed version. The Publisher's final version can be found by following the DOI link.The programme of Physician Associate (PA) is a relatively new Master (MSc) in the United Kingdom (UK) to train future health care professionals that will work under the supervision of a medical doctor as part of a medical team. Although PAs cannot prescribe, they will provide crucial support to doctors by dealing with patients in general practitioner surgeries or hospitals. The UK Department of Health (DoH) in collaboration with the Royal College of Physicians and the Royal College of General Practitioners has stablished the Competence and Curriculum Framework for the physician associate qualification. The minimum length of the programme is 90 weeks, equivalent to 3,150 hours of nominal study time, with a minimum of 1,600 hours assigned to clinical learning. The DoH also has published the matrix specification of core clinical requirements for the PA, in which the competences for diagnosing and managing different medical conditions are described. In relation to human parasitic infections, the core clinical conditions for PAs have been divided into different categories as follows: 1A) is able to diagnose and manage, without referral, threadworms (Enterobius vermicularis) and hookworms (Ancylostoma duodenale and Necator americanus); 1B) is able to identify and take measures to avoid immediate deterioration of amebiasis (Entamoeba histolytica) and malaria (Plasmodium spp.); and 2B) is able to undertake the day-to-day management of the patient when diagnoses has been made for toxoplasmosis (Toxoplasma gondii). De Montfort University (DMU, Leicester, UK) has launched the MSc Physician Associate Studies as part of its curricula in 2017/18. In order to develop clinical medical parasitology skills and reflection/critical thinking of the PA students, we have developed and implemented a two hour workshop in the module “Community Health”, in which PA students (n=12) have used the novel website resource DMU e-Parasitology to resolve two highly interactive virtual clinical case studies related to Entamoeba histolytica and Plasmodium spp. The DMU e-Parasitology, which is being developed by three European universities, is aimed to facilitate the teaching and learning of parasitology and it is publicly available through the DMU website: http://parasitology.dmu.ac.uk. Briefly, the virtual case studies provide the user with a medical history of a patient and different clinical slides to diagnose the parasitic diseases by their identifiable structures and characteristics using a virtual microscope. The user will navigate through different interactive questions and mini quizzes to reach diagnoses, management, treatment and tailor prevention techniques for the case study proposed. The workshop was well-received by PA students, as evidenced by their favourable evaluation. The PA students that completed the voluntary questionnaire indicated that the design used to build the module of the virtual case studies was appropriate (50% agreed, 50% strongly agreed). A similar percentage reported that the exercises and assessments presented were easy to understand and appropriate for their studies (75% agreed, 25% strongly agreed). Finally, participants indicated that they gained appropriate knowledge of the pathology, prevention and treatment of malaria and amebiasis (25% agreed, 75% strongly agreed). This paper describes tools, methods and strategies that can be easily adopted for implementing new ways of teaching and learning medical parasitology and clinical skills