BMC Public Health 2007, 7:219 http://www.biomedcentral.com/1471-2458/7/219 Table 4: Patient care experiences reported by respondents to NTCC Survey, 2005. Number of patients with latent tuberculosis infection (LTBI) or active tuberculosis (TB) cared for during their academic program to date as reported by students in six clinical disciplines (clinical laboratory sciences and public health students did not answer this question). Response None 1–3 patients 4–6 patients > 6 patients Total (% of respondents) Medicine MD/DO N (%) 130(26.8) 246(50.7) 65 (13.4) 42 (8.7) 483(36.3) Physician Assistants PA N (%) 47 (47.0) 36 (36.0) 5 (05.0) 12 (12.0) 100 (7.5) Under- graduate Nursing BSN N (%) 139(55.4) 83 (33.1) 11 (4.4) 18 (7.2) 251(18.9) Advanced Practice Nursing NP/APN N (%) 38(41.3) 28(30.4) 6 (6.5) 19(20.7) 91 (6.8) Pharmacy PharmD N (%) 275(75.5) 63 (17.3) 12 (3.3) 14 (3.8) 364(27.3) Respiratory Therapy RT N (%) 16(38.1) 15(35.7) 3 (7.1) 8 (19.0) 42 (3.2) Total N (%) 645 (48.5) 471 (35.3) 102 (7.7) 113 (8.5) 1331* * Three students did not answer this question professions students, primarily outside of the U.S.A. For example, Kilicaslan et al. [20] evaluated undergraduate training on TB at Istanbul Medical School and found among fourth-year medical students (n = 828) many incorrect answers. They also reported examination ques- tions did not adequately reflect WHO learning objectives for medical schools, published in 1998 [21]. Kurane and Kudoh [22] administered two sets of questionnaires to physicians in 80 medical school hospitals in Japan in 2002. They concluded additional education was needed for physicians and medical students. Bai et al. [23] admin- istered a survey to final year medical students in Hunan province of China in 2000 and came to similar conclu- sions. In contrast, Emili et al. [24] assessed final year med- ical students from Canada, India, and Uganda. They concluded although there were significant differences in undergraduate exposure to TB, total knowledge, and prac- tice competency among these students, the TB knowledge base and practice competency was adequate. In our study, students received TB education primarily from lectures and case discussions or case studies. Lectures are a passive learning modality that does not appeal to many of today's learners who prefer more active strategies [25,26]. Although case discussions and case studies are types of active learning used by almost half of the students (46%), other more active strategies such as standardized patients, games, and computer simulations were used much less frequently. An NTCC objective is to develop educational materials using active-learning strategies. Sev- eral products are now available on the NTCC website [14] by NTCC and other faculty. In addition, NTCC faculty are currently integrating NTCC-developed materials into their curricula for the 2007 and 2008 academic years and will survey students again in Spring 2008 to determine whether these materials have had any impact on their knowledge, attitudes, and confidence in caring for patients with LTBI or TB. Limitations of the study There are several limitations to our study. First, the surveys were administered to students in only 28 programs among the hundreds of programs in the United States of America. Most NTCC faculty are affiliated with academic institutions in high TB incidence states, and a few are from low TB incidence states, but the annual incidence of TB in the United States is overall quite low (fewer than 15,000 new cases in 2005 [5]). Accordingly, many students had little or no experience caring for LTBI or TB patients. Sec- ond, the response proportion in the seven clinical disci- plines was quite good (almost 65%) for a voluntary survey; however, we still sampled fewer than 1500 of the many thousands of health professions students in the U.S.A., making it inappropriate to generalize these results to all health professions students. Third, survey questions were developed by the NTCC from a variety of sources because a standardized survey instrument was not availa- ble. Throughout the survey development process, ques- tions were reviewed and modified several times, and consensus was gained by each discipline group for each final version; formal instrument development was not done. Similar to test analyses conducted by UCSD EdCom for multiple-choice tests administered in academic courses, a test analysis was conducted for the five knowl- edge questions (Table 2: questions 6–10). The test analy- sis showed that these questions had adequate to good discrimination, efficiency, and correlation indices (B. Stanonik, personal communication); however, we would have greater confidence about their validity and reliability had we conducted a formal instrument development pro- cedure. Conclusion The NIH-NHLBI funded the NTCC to develop products to improve knowledge of TB in health professions students in the U.S.A. based on the assumption that there was a need. This study supports that need by demonstrating Page 6 of 8 (page number not for citation purposes)