Medical Entomology Training for Medical Practitioners
Medical Entomology Training for Medical Practitioners
Medical student training (the 4-year standard course) has changed dramatically since World War II. The amount of basic biological information that each medical student is required to master in the preclinical curriculum has vastly increased; coverage of many traditional, classical disciplines has, therefore, been dropped to make way for voluminous information in rapidly expanding areas such as molecular biology, genetic testing/counseling, neuroscience, and pharmacology. Examples of classic disciplines dropped to make way for new ones include parasitology and medical entomology. The Association of American Medical Colleges maintains a detailed comparison of curricula of participating American and Canadian medical schools as an online searchable database named CurrMIT. A recent search of CurrMIT using the keyword "arthropods" revealed that only 11 of 120 participating institutions include arthropods in course content. For most of these institutions, information on arthropods comprises only a small part of a course in microbiology or pathology.
Designers of medical school curricula may be assuming that information pertaining to the pathogenesis and identification of arthropods is a component of the training of medical laboratory technologists/clinical laboratory scientists. Two organizations that administer national examinations to certify clinical laboratory scientists, however, do not include medical entomology as part of the examination content. The American Society of Clinical Pathologists has recommended that material related to arthropods should be "deleted or should not be included in the curriculum" for medical technology. The National Credentialing Agency for Laboratory Personnel provides a detailed content-outline of the certification examination for clinical laboratory sciences. A thorough search of this content-outline revealed that medical entomology is not even considered important in the knowledge base of an entry-level clinical laboratory scientist. The question then becomes, which, if any, health care professional is being trained in medical entomology?
Unless another major war is fought in the tropics, it is unlikely that courses in medical entomology and parasitology will return to medical training. The best that can be hoped for is inclusion of a block of material on medical parasitology within medical microbiology courses, and inclusion of a few medical entomology lectures (perhaps including laboratory experience) within that medical parasitology block. There is, however, a definite need for broader coverage of these subjects. The importance of entomology and parasitology in health-care-worker training is highlighted by recent examples of vector-borne tropical diseases being introduced into the urban environment by rapid modern air travel. The latest example of this is the introduction of West Nile encephalitis to the eastern United States. In fact, a large portion of tropical diseases are caused by or transmitted by arthropods and parasites. Immigration, both legal and illegal, combined with rapid international air travel, increasingly bring these diseases into industrialized countries. Compounding the situation, the number of international departures from airports in the United States doubled in a 12-year span, climbing from 20 million in 1983 to nearly 40 million in 1995; more than 50% of those departures each year were bound for tropical countries. A report by the Institute of Medicine has identified "increases in travel and commerce" as a major contributor to infectious disease emergence and reemergence. Even a cursory scan of the medical literature will yield numerous citations of imported cases of myiasis, malaria, yellow fever, dengue, intestinal parasites, and West Nile encephalitis, all of which are related to various insects or parasites. Who is going to be able to recognize arthropod or worm pests in the clinical setting? Identification of these organisms and subsequent advice on treatment, prevention, and control are complex issues for which medical technologists should not be the solely responsible. One of us (J.G.) often gets entomologic specimens for identification from laboratory personnel (specimens originally sent from physicians) who do not know to which major group the organism belongs. In one such recent case, a soft tick (family Argasidae) was removed from a patient's ear by a physician who called it a "baby crab". Additional physician training is clearly needed. Just as is the case with microbial agents, treatment or control recommendations for arthropod problems hinge on correct identification, a skill that is best acquired with hands-on training.
Medical student training (the 4-year standard course) has changed dramatically since World War II. The amount of basic biological information that each medical student is required to master in the preclinical curriculum has vastly increased; coverage of many traditional, classical disciplines has, therefore, been dropped to make way for voluminous information in rapidly expanding areas such as molecular biology, genetic testing/counseling, neuroscience, and pharmacology. Examples of classic disciplines dropped to make way for new ones include parasitology and medical entomology. The Association of American Medical Colleges maintains a detailed comparison of curricula of participating American and Canadian medical schools as an online searchable database named CurrMIT. A recent search of CurrMIT using the keyword "arthropods" revealed that only 11 of 120 participating institutions include arthropods in course content. For most of these institutions, information on arthropods comprises only a small part of a course in microbiology or pathology.
Designers of medical school curricula may be assuming that information pertaining to the pathogenesis and identification of arthropods is a component of the training of medical laboratory technologists/clinical laboratory scientists. Two organizations that administer national examinations to certify clinical laboratory scientists, however, do not include medical entomology as part of the examination content. The American Society of Clinical Pathologists has recommended that material related to arthropods should be "deleted or should not be included in the curriculum" for medical technology. The National Credentialing Agency for Laboratory Personnel provides a detailed content-outline of the certification examination for clinical laboratory sciences. A thorough search of this content-outline revealed that medical entomology is not even considered important in the knowledge base of an entry-level clinical laboratory scientist. The question then becomes, which, if any, health care professional is being trained in medical entomology?
Unless another major war is fought in the tropics, it is unlikely that courses in medical entomology and parasitology will return to medical training. The best that can be hoped for is inclusion of a block of material on medical parasitology within medical microbiology courses, and inclusion of a few medical entomology lectures (perhaps including laboratory experience) within that medical parasitology block. There is, however, a definite need for broader coverage of these subjects. The importance of entomology and parasitology in health-care-worker training is highlighted by recent examples of vector-borne tropical diseases being introduced into the urban environment by rapid modern air travel. The latest example of this is the introduction of West Nile encephalitis to the eastern United States. In fact, a large portion of tropical diseases are caused by or transmitted by arthropods and parasites. Immigration, both legal and illegal, combined with rapid international air travel, increasingly bring these diseases into industrialized countries. Compounding the situation, the number of international departures from airports in the United States doubled in a 12-year span, climbing from 20 million in 1983 to nearly 40 million in 1995; more than 50% of those departures each year were bound for tropical countries. A report by the Institute of Medicine has identified "increases in travel and commerce" as a major contributor to infectious disease emergence and reemergence. Even a cursory scan of the medical literature will yield numerous citations of imported cases of myiasis, malaria, yellow fever, dengue, intestinal parasites, and West Nile encephalitis, all of which are related to various insects or parasites. Who is going to be able to recognize arthropod or worm pests in the clinical setting? Identification of these organisms and subsequent advice on treatment, prevention, and control are complex issues for which medical technologists should not be the solely responsible. One of us (J.G.) often gets entomologic specimens for identification from laboratory personnel (specimens originally sent from physicians) who do not know to which major group the organism belongs. In one such recent case, a soft tick (family Argasidae) was removed from a patient's ear by a physician who called it a "baby crab". Additional physician training is clearly needed. Just as is the case with microbial agents, treatment or control recommendations for arthropod problems hinge on correct identification, a skill that is best acquired with hands-on training.
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