Immunizations
OVERVIEW
Immunization has been cited as one of the top 10 public health
achievements of the 20th century. Every day in the United
States, 11,000 babies are born who must be vaccinated. To
be protected against 10 vaccine-preventable diseases, they
should receive 14-18 doses of vaccines by 18 months of age
and 19-23 doses through childhood. Adult vaccines continue
to be underutilized. Students will be challenged to learn
the large body of knowledge to be able to immunize our population
effectively against vaccine-preventable illnesses. Fortunately,
there are great Internet and PDA resources so that much of
this immunization information does not need to be memorized
and can be easily accessed with good information management
skills. Additionally, students must learn the skills needed
to communicate with patients and parents of patients clearly
and sensitively about the risks and benefits of vaccines.
Finally, students must be able to administer vaccines correctly.
TOPIC LEARNING GOALS AND OBJECTIVES
(Organized by ACGME Competencies)
Patient Care
GOAL: Students will recommend timely vaccinations based on
age, medical conditions, lifestyle, and environment.
OBJECTIVES: Students will be able to:
- Describe the CDC vaccine schedule for children and adults
and access the detailed schedule on the Web or on a handheld
computer (e.g., http://www.immunizationed.org).
- Understand the rationale for vaccine indications based
on lifestyle and environment.
- Apply the Recommended Childhood and Adolescent Immunization
Schedule and the Recommended Adult Immunization Schedule
to a patient or scenario.
GOAL: Students will apply contraindications appropriately,
and take advantage of every opportunity for immunization.
OBJECTIVES: Students will be able to:
- State major contraindications.
- Access details of contraindications (e.g., Web site or
handheld software).
- Determine when live vaccines can be dangerous for patients
who were immunosuppressed or immunosuppressed contacts of
patients receiving the vaccine.
GOAL: Students will administer vaccines appropriately.
OBJECTIVES: Students will be able to:
- Distinguish between common, minor side effects versus
rare serious effects (the latter should be reported to the
Vaccine Adverse Event Reporting System ( http://www.vaers.org/.)
- Distinguish between vaccine delivery using the intramuscular
versus the subcutaneous route and site.
- Demonstrate the ability to draw up a vaccine and deliver
it using appropriate site and the right needle size.
Medical Knowledge
GOAL: Students will explain the vaccines, the diseases they
prevent, and the recommended schedules for administration.
OBJECTIVES: Students will be able to:
- List and describe the common viral and bacterial diseases
for which we vaccinate our population, including communicability.
- Discuss communicability and transmission routes.
- List which vaccines contain live organisms.
- Discuss why some vaccines are conjugated.
- Describe the appropriate timing for vaccine delivery.
- Discuss why there are minimal intervals between vaccines.
- Discuss why there is no need to restart a vaccine series
if there is a delay in the schedule.
- Describe the public health burden of these diseases prior
to widespread vaccination and the subsequent declines in
disease due to vaccination.
Practice-Based Learning and Improvement
GOAL: Students will understand the barriers that prevent
higher immunization rates among our children and adults.
OBJECTIVES: Students will be able to:
- Explain how health disparities based on income and lack
of health insurance contribute to under-immunization.
- Discuss vaccine financing.
- List typical missed opportunities for immunizations in
medical settings.
- List methods by which doctors and health departments can
increase immunization rates.
- Discuss how misinformation on vaccine-related adverse
events affects immunization rates and disease.
- Discuss local resources for vaccination.
Interpersonal and Communication Skills
GOAL: Students will discuss benefits and risks of vaccines
with patients and parents of patients clearly and sensitively.
OBJECTIVES: Students will be able to:
- Provide / discuss vaccine risk-benefit information to
patients and parents of patients when offering vaccinations
(e.g., provision of the CDC Vaccine Information Statements
from http://www.cdc.gov/nip/publications/VIS/default.htm).
- Describe the importance of preventing vaccine preventable
diseases.
- Communicate effectively with patients and parents that
have worries or concerns about the use of vaccinations.
Professionalism
GOAL: Students will establish and adhere to high personal
standards in the provision of immunizations to patients.
OBJECTIVES: Students will be able to:
- Communicate honestly and openly with patients and families
about the personal and public health issues surrounding
our national immunization program.
Systems-Based Practice
GOAL: Students will appraise and utilize the best practice
guidelines based on the most current available information
to recommend immunizations and to raise immunization rates.
OBJECTIVE: Students will be able to:
- Develop a critical approach to making health care decisions
for individuals and groups by using quality indicators (e.g.,
USPSTF, HEDIS), community and national health data, guidelines
(e.g., AHRQ, managed care), cost data, and EBM applications
(on the Internet or PDA).
- Find and use the CDC National Immunization Program website
and other high-quality Web sites as resources for finding
and evaluating evidence-based clinical practice guidelines www.cdc.gov/nip.
- Find and use the Web site of the Task Force on Community
Preventive Services that rates the evidence on ways to increase
immunization rates http://www.thecommunityguide.org/vaccine/default.htm.
EDUCATIONAL METHODS AND RESOURCES
Teaching Strategies
- Lectures (see slide sets on http://www.immunizationed.org )
- Small-group cases from the Teaching Immunization for Medical
Education (TIME) program
- Preceptor-student interaction on actual clinical cases
- Independent reading
Integration Strategies
- Immunization theory is typically covered in infectious
disease or host defense courses in preclinical years. Actual
practice is covered in primary care clerkships (e.g., family
medicine).
Clinical Experience
- Counsel patients and parents of patients in clinical settings.
Review vaccine indications and contraindications for individual
cases with preceptor. Learn to prepare and give vaccines
in clinical settings.
Independent Learning
- The CDC Web site http://www.cdc.gov/nip/ contains
a wealth of information on immunizations and is a great
resource for independent learning.
- Teaching Immunization Delivery and Education (TIDE)
TIDE is a Web-based interactive provider education curriculum
designed to give faculty, students, residents, and practitioners
a flexible tool to teach and learn immunization delivery. All
work is completed on-line. Organized in four modules (childhood
immunizations, assessing immunization rates, improving rates
in your practice, and adolescent immunizations), it is self
paced and offers continuing education credits for physicians
and nurses. http://www2.edserv.musc.edu/tide/menu.lasso
- Textbooks and Journal Supplements as listed below.
Small-Group Learning/Problem-Based Learning
- Small-group cases from the Teaching Immunization for Medical
Education (TIME) program
Curricular Resources
- ATPM's medical education materials were developed through
the Teaching Immunization for Medical Education (TIME) Project,
a collaborative initiative of ATPM, the Department of Family
Medicine, University of Pittsburgh School of Medicine and
CDC. Materials developed through this initiative are referred
to as the TIME Resource.
http://www.atpm.org/
The TIME Resource consists of case-based modules in two
teaching formats:
- Multistation Clinical Teaching Scenarios (MCTS).
Topics in this series include: adult vaccination, childhood vaccination,
Haemophilus influenzae type b, hepatitis B, influenza, measles,
and pertussis.
- Problem Based Learning (PBL).
The PBL series consists of modules for hepatitis B, influenza,
measles, and pertussis.
The modules focus on vaccine indications and contraindications,
immunization schedules, and efficient ways to increase vaccination
levels and decrease missed opportunities to vaccinate. They provide
a comprehensive package of ready-to-use instructional materials
that can be easily integrated into existing curriculums.
The PBL modules are free. They are designed for use with
first- and second-year medical students within schools of
medicine with PBL tracks.
Each MCTS packet consists of:
- a facilitator's guide
- 3 small-group booklets, each of which can be used with
3-4 students
- the reference articles
Each disease-specific topic has 5 to 6 teaching scenarios
that can be covered in 60-90 minutes, depending on the questions
raised and the facilitator's teaching style.
Both the MCTS and PBL approach present medical students and
residents with case scenarios to be discussed in small groups.
MCTS offers a number of cases for analysis while the PBL approach
focuses on a core case. Both methods employ small-group contextual
learning techniques demonstrated to be highly effective in
facilitating learner problem-solving skills and content knowledge.
Both methods encourage active student participation. The PBL
approach encourages student- directed assessment of case scenarios
whereas a facilitator guides the MCTS process. Some of the
TIME products are available for free at http://www.atpm.org.
Published Material
Lectures
- These slides were provided courtesy of the Centers for
Disease Control and Prevention; Richard K. Zimmerman, MD,
University of Pittsburgh; and Richard D. Clover, MD, University
of Louisville. Additional slide presentations appropriate
for use by educators will be developed for this site.
http://www.immunizationed.org/Downloads.asp
Web Sites
General
- The National Immunization Program
http://www.cdc.gov/nip/default.htm
- The Group on Immunization Education (GIE) of the Society
of Teachers of Family Medicine is dedicated to improving
the knowledge of family medicine educators by providing
information about immunizations and strategies to transmit
this knowledge to students and residents. The Group also
has copies of the latest Recommended Childhood Immunization
Schedule and the Recommended Adult Immunization Schedule.
http://www.immunizationed.org/
- Shots
2004 is a quick reference guide to the annual Recommended
Childhood and Adolescent Immunization Schedule, and the Recommended
Adult Immunization Schedule that is recommended by the Advisory
Committee on Immunization Practices (ACIP). Details on each
vaccine are available by clicking on the vaccine names. Available
free for PDAs and on the Web.
http://www.immunizationed.org/
- American Academy of Family Physicians
The annual Recommend Childhood and Adolescent Immunization Schedule
and the Recommended Adult Immunization Schedule as well as other
Academy immunization policy statements are available on the
AAFP Immunization Website at:
http://www.aafp.org/x10615.xml
These documents are also available through the AAFP Order Department
at (800) 944-0000. The schedules have also been promoted to the
AAFP Constituent Chapters for promotion at their meetings and
through their newsletters.
- In addition, immunization information is promoted at the
AAFP's Annual Scientific Assembly, through the AAFP's 2004
Annual Clinical Focus program (Caring for America's Aging
Population), American Family Physician and the Family Practice
Management journals, and through other venues such as CME
activities and monographs.
- Immunization Action Coalition is a premier source of childhood,
adolescent, and adult immunization information and hepatitis
B educational materials. Resources include newsletters,
pictures and stories of persons harmed by vaccine preventable
diseases, and periodic emails of electronic updates of important
vaccination news.
http://www.immunize.org
- The National Network for Immunization Information (NNII)
provides up-to-date, science-based information to health
care professionals, the media, policy makers, and the public
-- everyone who needs to know the facts about immunization.
The Information provided includes NNII Immunization Newsbriefs,
an easy way to keep on top of the latest vaccine issues
in the news.
http://www.immunizationinfo.org/
- National Partnership for Immunization
The mission of NPI is to encourage greater acceptance and use
of immunization for all ages through partnerships with public
and private organizations.
http://www.partnersforimmunization.org/
- Task Force for Community Preventive Services
The Community Guide's systematic review of the effectiveness of
selected population-based interventions aimed at improving vaccination
coverage in children, adolescents and adults focused on strategies
within three strategic areas:
http://www.thecommunityguide.org/vaccine/default.htm
- Increasing community demand for vaccinations
- Enhancing access to vaccination services
- Provider-based interventions
Infants and Children
Pregnant Women
Adolescents and Adults
Travel Health
Potential State Partners
Health People 2010 Immunization Objectives
National Extension Immunization Workgroup
Multimedia
- Several picture galleries are available on the web, containing
photographs of vaccine preventable diseases. Many of these
images were acquired from the Public Health Image Library,
sponsored by the Centers for Disease and Prevention. They
may be used by educators for teaching purposes. The images
in this collection are in the public domain and are thus
free of any copyright restrictions. For public domain images,
permission is not required, but we ask that you credit the
original institution and contributor (when known) whenever
the image is used in any publicly distributed media.
http://phil.cdc.gov/Phil/default.asp
http://www.vaccineinformation.org/photos/index.asp
http://www.immunizationed.org/diseases.asp
Contact People
- The Group on Immunization Education (GIE) of the Society
of Teachers of Family Medicine is dedicated to improving
the knowledge of family medicine educators by providing
information about immunizations and strategies to transmit
this knowledge to students and residents.
http://www.immunizationed.org/
ASSESSMENT STRATEGIES
- Sample Quizzes are available from the TIME project.
- Chart stimulated recall is a useful technique to test
medical students.
FACULTY DEVELOPMENT
BUDGETARY CONSIDERATIONS
- Web access to Vaccines across the Life Span , Supplement
to the Journal of Family Practice is free.
- Some of the TIME resource modules are free from http://www.atpm.org
- The PDA software Shots 2004 is free.
- TIDE self-instruction materials are free.
Lead Author: Richard Usatine, MD
Contributing Authors: Richard Zimmerman, MD, MPH, Donald Middleton,
MD, and Sanford Kimmel, MD
Clerkship/Post-Clerkship Workgroup members: Ann O'Brien-Gonzales,
PhD (Chair), Alexander Chessman, MD (EC Liaison), Caryl Heaton,
DO, Janice Nevin, MD, MPH, Lauren Oshman, MD, Deborah McPherson, MD,
Mark. E Quirk, EdD, David Schneider, MD, MSPH, William B. Shore,
MD, Richard Usatine, MD
Family Medicine Curriculum Resource (FMCR) Project HRSA Contract
240-00-0107.
Revised February 18, 2004 |
