BMC Public Health 2007, 7:219 http://www.biomedcentral.com/1471-2458/7/219 Background Between 1985 and 1992, there was a dramatic increase in the incidence of tuberculosis (TB) in the United States, and the epidemiology of TB changed [1]. In retrospect, it became clear that this increase was due, in part, to trans- mission of TB in hospitals and prisons, and that health care workers, in addition to physicians, were at risk for infection [2-4]. Although the number of cases and inci- dence of TB decreased substantially over the next decade and are now decreasing at a much slower rate (e.g., 14,515 cases in 2004 compared to 14,097 cases in 2005), the pro- portion of TB cases in foreign-born people continues to increase (29% in 1993; 55% in 2005) and is a focus for surveillance and control efforts in the U.S. [5]. In recent years, treatment and prevention of TB has shifted from inpatient to outpatient settings. Much of the care is pro- vided by TB specialists in public health departments and by physicians in general practices who deal with TB in the context of delivering broader services. There has also been a growing trend for health care to be provided by non- physician-clinicians [6]. There is increasing evidence that non-physician clinicians in many disciplines can provide high-quality care, with the strongest evidence derived from care at the least complex end of the clinical spectrum [7,8]. Team care models with respiratory therapists and pharmacists are increasingly more common in critical care settings [9]. Despite the shared functions, these profes- sionals receive very different training, both in the U.S.A. and internationally. Since the resurgence of TB almost two decades ago, there has been increasing concern about education and compe- tence of healthcare providers to deal with specialized issues of TB prevention and treatment. Many educational materials on all aspects of TB are produced by national and international agencies such as the Centers for Disease Control and Prevention, the National Institute of Allergy and Infectious Diseases, the World Health Organization, and the International Union Against Tuberculosis and Lung Diseases; health departments; educational and research institutions; and non-profit organizations such as the American Thoracic Society. With the wealth of materials on all content areas of TB, it is disconcerting that clinicians still make frequent errors in TB treatment [10] and there is an expressed need to educate prospective and practicing healthcare workers on TB infection manage- ment and control [11]. A major step in improving TB education in the U.S. involved the creation of the National Tuberculosis Curric- ulum Consortium (NTCC) consisting of over 40 multi- disciplinary educators and leaders in 25 academic institu- tions and affiliates throughout the U.S. (Appendix). The NTCC is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health for five years (10/03 – 9/08). The goal of the NTCC is to improve knowledge of tuberculosis in students in health profes- sions schools throughout the U.S.A. The NTCC is organ- ized around sets of competencies for students in eight health disciplines: medicine (MD/DO) [12], undergradu- ate nursing (BSN) [13], advanced practice nursing (NP/ APN), physician assistants (PA), pharmacy (PharmD), respiratory therapy (RT), clinical laboratory sciences (MT/ CLS), and public health (MPH). Consortium members representing each discipline are charged with developing products that focus on the discipline-specific competen- cies. These products will be used by faculty in NTCC schools to teach about TB. The materials are also available via the NTCC website [14] to faculty in other schools as well as organizations that provide continuing education and lifelong learning. To assess students for basic knowledge of TB and how confident they feel about taking care of persons with latent tuberculosis infection (LTBI) or active TB, a Student TB Survey was developed and administered in 2005. The purpose of the initial survey described in this article was to provide a baseline level of knowledge, attitudes, and confidence about tuberculosis by surveying students enrolled in NTCC schools prior to NTCC-developed edu- cational materials being made available to faculty. Methods Study population A total of 2965 students in 28 programs in 20 NTCC schools were potential subjects for the study. Instrument development The survey instruments were designed by members of the NTCC using materials that included content and ques- tions from two Centers for Disease Control and Preven- tion publications, The Core Curriculum on Tuberculosis [15] and the Self-Study Modules on Tuberculosis [16]. In addi- tion, questions from a TB survey administered to medical students at the University of Southern California (USC) in 2002 were used as a starting point. These questions were developed by USC infectious diseases faculty in collabora- tion with the TB Control Officer for Los Angeles County and were administered to about 150 medical students by a graduate student in the Master of Public Health Degree Program at California State University, Northridge (L. Acevedo and B. Jones, personal communication). Addi- tional demographic, background, and confidence ques- tions were developed by NTCC members. Unique versions of the survey were developed for each of the 8 dis- ciplines (medicine [MD/DO], undergraduate nursing [BSN], pharmacy [PharmD], physician assistants [PA], advanced practice nursing [NP/APN], respiratory therapy [RT], clinical laboratory sciences [MT/CLS], and public health [MPH]) with the first 18 questions common to all Page 2 of 8 (page number not for citation purposes)