BMC Public Health 2007, 7:219 http://www.biomedcentral.com/1471-2458/7/219 Although almost all students knew TB was most com- monly transmitted from person-to-person via aerosols (Question 6), about one-third did not know the correct method for administering tuberculin (Question 7) or that BCG was not a contraindication to TB skin testing (Ques- tion 8). Fewer than two-thirds knew that about 10% of people in the U.S. who have LTBI and a normal immune system will go on to develop TB at some point in their lives (Question 9), or that the reason BCG is not part of routine vaccination programs in the U.S. is because it complicates surveillance for LTBI (Question 10). It is well-established that LTBI and active TB are more common among foreign-born individuals, and that for- eign-born students are more likely to have received BCG vaccine than students born in the U.S. [17]. To evaluate these factors, "Were you born outside the U.S.A. or Can- ada (are you foreign born)?" was asked as a general ques- tion. Among the 1469 students who responded to this question, almost one-quarter (22.9%) reported they were born outside the U.S.A. or Canada. Of the foreign-born, the majority (72%) were in medicine and pharmacy pro- grams. As expected, a significantly higher proportion of foreign-born students had been diagnosed with LTBI (14.9% vs. 3.9%), had been treated for LTBI (6.5% vs. 1.7%), and had received BCG vaccine (33.6% vs. 1.3%). Table 3 shows general beliefs about TB education. The majority (90.5%) disagreed with the statement, "There is only minimal need for more education on TB because it is not likely that I will need it in my chosen career," and with the statement, "The career path I have chosen will not require me to know much about TB" (85.8%). The major- ity (85.7%) agreed, "TB education is very important in my academic program." The majority, although to a lesser extent (70.0%), agreed "The current emphasis on TB in my academic program is adequate". There was more ambivalence (agreement = 61.3% vs. disagreement = 38.7%) about the question, "In my future plans as a health professional, I am confident that the level of TB knowledge I have attained is adequate to prepare me for my career needs." Table 4 shows the number of patients with LTBI and active TB cared for by students during their academic program to date. A substantial proportion had cared for no LTBI or TB patients during their program, varying from a low of 26.8% among medical students to a high of 75.5% among pharmacy students. Most students who had cared for at least one patient had cared for fewer than 4 patients. About 20% of NP/APN and RT students had cared for more than 6 patients. Discussion In a recent editorial, Jensen [18] commented on a study of medical students in Brazil [19]. Both authors strongly rec- ommended providing better education about TB to med- ical and other health professions students. Teixeira et al. [19] found that 10.3% of medical students did not under- stand that M. tuberculosis is transmitted by coughing (24.3% of students in pre-clinical years and 2.4% in late clinical years). This is similar to our overall findings wherein almost 10% did not know TB organisms were most commonly transmitted from person-to-person via aerosols. Among our medical students, however, most of whom were near completion of their training, 95% knew the correct answer which is more consistent with Teixeira et al.'s findings for medical students in their late clinical years. We were pleased that most students believed TB education was important to their academic program (Table 3, Ques- tion 2) and that their career path would require knowl- edge of TB (Table 3, Question 4). However, the fact that 30% of students disagreed the current emphasis on TB in their academic program was adequate (Table 3, Question 3) is consistent with finding that four of the five basic TB questions were answered incorrectly about one-third of the time (Table 2, Questions 7–10), and almost 40% of the respondents were not confident their level of TB knowledge was adequate for their career needs (Table 3, Question 5). Our findings are also similar to those of several other investigators who have conducted surveys among health Table 3: General beliefs about tuberculosis education from NTCC Survey, 2005 (N = 1480). Responses were recorded on a 4-point Likert-type scale (Strongly Disagree = 1, Disagree = 2, Agree = 3, Strongly Agree = 4). For this table, responses have been combined into two categories: Disagree (SD + D) and Agree (A + SA). Statement 4 point mean Disagree N (%) Agree N (%) 1. There is only minimal need for more education on TB because it is not likely that I will need it in my chosen career. 2. TB education is very important to my academic program. 3. The current emphasis on TB in my academic program is adequate. 4. The career path I have chosen will not require me to know much about TB. 5. In my future plans as a health professional, I am confident that the level of TB knowledge I have attained is adequate to prepare me for my career needs. 1.66 3.16 2.74 1.76 2.62 1388 (90.5) 211 (14.3) 444 (30.0) 1267 (85.8) 573 (38.7) 140 (9.5) 1267 (85.7) 1038 (70.0) 209 (14.2) 906 (61.3) Page 5 of 8 (page number not for citation purposes)