Title: Clinical Decision-Making for Drug-Resistant Tuberculosis (Acronym DR-TB)
Keywords: Treatment
TB
Microbial resistance
Medical & Clinical sciences (EBM incl..)
Country: Belgium
Institution: Belgium - Antwerp Institute of Tropical Medicine
Course coordinator: Prof Dr Lutgarde Lynen (ITM Clinical Sciences Department)
Prof Dr Bouke de Jong (ITM Biomedical Sciences Department)
Date start: 2018-02-19
Date end: 2018-05-24
About duration and dates: 8 weeks part-time at distance and 8 days face-to-face, 19-02-2018 to 27-04-2018 distance learning (includes a break of 2 weeks) 14-05-2018 to 24-05-2018 face-to-face
Classification: advanced optional
Mode of delivery: Blended-learning
Course location: Institute of Tropical Medicine (ITM), Nationalestraat 155, 2000 Antwerp, Belgium
ECTS credit points: 5 ECTS credits
SIT: Distance learning: 74h online + 12h self-study= 86h
Face-to-face: 52h contact hours (6,5 hrs / day) + 5h self-study (case study preparation)= 57h
Total: 143 hrs
Language: English
Description:
At the end of this course, participants should be able to:

• Define the problems with DR TB in their country in terms of occurrence, diagnosis and treatment, using available data;
• Assess harm and benefit of clinical decisions in the field of DR TB diagnosis and treatment;
• Formulate contextualized evidence-based recommendations for the prevention, diagnosis and treatment of DR TB for case studies from different contexts
Assessment Procedures:
Summative assessment of the participants is based on participation during the online part (exercises/assignments based on case studies presented by faculty and online discussions) and development of a case study originating from the participant’s own context with a presentation of recommendations at the end of the face-to-face part.

Final score calculation:

The final score is based on five online assignments (1. Critical review of DR-TB cascade in their country, 2. Analysis of DR-TB diagnostic methods available in their country and a proposal for a diagnostic flowchart, 3. Peer review and feedback on the diagnostic flowchart of other participants, 4. Discussion on challenges to access new DR-TB drugs and regimens, 5.Quiz on the building of a conventional and short MDR-TB regimen) during the online part (50%) and a personal project during the F2F part; analysis of a case study with recommendations for DR-TB care contextualized to the setting of the participants (50%). This personal project is presented and defended in front of a jury of DR-TB experts. This final assessment includes 10 minutes presentation and 10 minutes for “questions and answers”.

1. As the face-to-face part builds on the online part, participants who fail to participate during the online part in at least 7 out of 8 discussion forums will not be allowed to join the face-to-face part in Antwerp; participants also fail if they don’t submit all 5 online assignments.

2. Criteria for the score on the presentation of the case study during the face-to-face part will consist of the following:

• introduction (context of the program, patient history, clinical presentation, available lab results) & problem statement;

• formulation of recommendations for diagnostic tests and treatment within the current program;

• balance benefit / harm of clinical decisions;

• formulation of recommendations for implementation of new diagnostic tools / treatment to treat optimally the described case.

Remark: The case study presented as final assessment differs from the first presentation of the case study. The focus of the first presentation (during class hours) is on presenting the context and the clinical challenge in the field of DR TB prevention, diagnosis and/or treatment, while the second presentation focusses on recommendations for clinical DR TB care and the DR TB program, to illustrate the take home messages the student retrieved from participation in the DR TB course.
Content:
The following subjects will be addressed:
• identification of persons to be evaluated for DR TB,
• epidemiology of DR-TB in the participant’s setting,
• diagnosis of DR TB using phenotypic and genotypic methods
• dealing with discordant diagnostic test results,
• DR TB classification,
• activity and therapeutic efficacy of the different TB drugs and regimens,
• criteria for choosing the most appropriate treatment regimens,
• clinical-decision making, and the concept of treatment threshold
• design of treatment regimens for patients with adverse drug events and/or resistance to one or more DR-TB drugs,
• management of DR TB patients with co-morbidities
• monitoring of treatment effectiveness (including efficacy and tolerance), surveillance of drug-resistance, and
• DR TB care program implementation, including new drugs and regimens.

During the online part the case studies are provided by the course faculty. During the F2F part, case studies are provided by the faculty and the participants.

The 8 weeks online phase address the following subjects:
• Epidemiology of DR TB in the participant’s setting (1 week, LO 1)
• Phenotypic and genotypic diagnostic tests for DR TB (2 weeks, LO 1)
• Drugs and regimens for DR TB treatment (2 weeks, LO 1)
• Clinical decision making in DR TB (2 weeks, LO 1 & 2)
• Implementation of new drugs and regimens (1 week, LO 1 & 3)
Methods:
At application, a written description of a topic that shows challenges with diagnosis and/or the treatment of DR TB (including the clinical problem description, type of patients affected, the importance of the problem, and how clinicians currently deal with this problem in his/her own setting; max length: ½ A4) is required. This topic will be further developed as a case study during the course.

During the online part each week contains an interactive lecture, an interactive discussion platform, and an assignment
Each week corresponds to an average of 10 hours student investment time.

Problem-based learning: During both parts (online and F2F) case studies are used. As such the learning experience fits as much as possible the problems experienced by participants in their programmatic setting. Moreover, face-to-face sessions often start with a case study presentation. Case studies are followed by an interactive debate between participants and experts. At the end of a session, the expert provides a lecture to complement the debate. As such the theory aligns well with the problems identified by participants.

Flipped learning: During the online part the F2F debates have been prepared. Most of the theory was digested at home, which allowed students to use the precious class time for interaction with peers and experts.
Participants have access to guidelines and other sources of evidence for consultation, and gaps in the evidence base are identified. Using specific examples, measures of test performance and the concept of treatment threshold in clinical decision making are addressed. In addition challenges and achievements in diagnosing and treating DR TB, as experienced by the participants, will be discussed. Students are requested to reflect as a group on the key learning points of the day and to summarize them the next morning.

The 8 days face-to-face builds further on the content addressed during the online part, and includes group discussions, case presentations, summary of key learning points by students, and interactive lectures (didactic lecturing takes 30% of the contact hours) on interpretation of different diagnostic tests (2 days), treatment of DR-TB (4 days) and implications of treatment, clinical decision-making (1 day), and the presentations of the final assignment by the participants (1 day) including discussions and formative assessment by DR-TB experts.
Prerequisites:
The course targets medical doctors involved for at least 25% of their time in clinical care for patients with DR-TB, in a setting where molecular diagnostic techniques, such as Xpert MTB/RIF and/or line probe assays, are available.
Participants should be holders of a medical university degree.
Candidates who are non-native English speakers or who have not already successfully completed higher education in English, must be able to prove their language proficiency with a certificate from a recognized institution (required level: TOEFL paper-based 580, computer-based 230, Internet-based 88 or IELTS 6.5. (ITM TOEFL Code: 7727).
Attendance:
Max 25 students
Selection:
Candidates will be selected based on the following criteria:
• Work experience in DR TB care;
• Profile of clinicians working in the field of DR TB as shown in the Curriculum Vitae;
• Motivation letter (including a description of the challenges in DR TB care you are confronted with and the commitment from own home institution in supporting your application);
• A written case study on the diagnosis and/or treatment of DR TB.
Fees:
1600 EUR
Scholarships:
ITM offers a limited number of scholarships with the financial support of different agencies. The Belgian Directorate General for Development is the main sponsor. See www.itg.be > education > scholarships
tropEd accreditation:
Accredited in Antwerp GA, October 2017. This accreditation is valid until October 2022.
Remarks:
Faculty:
Armand Van Deun, Damien Foundation and Institute of Tropical Medicine Antwerp, Department of Biomedical Sciences
Bouke de Jong, Institute of Tropical Medicine Antwerp, Department of Biomedical Sciences
Leen Rigouts, Institute of Tropical Medicine Antwerp, Department of Biomedical Sciences
Lut Lynen, Institute of Tropical Medicine Antwerp, Department of Clinical Sciences
Emmanuel Bottieau, Institute of Tropical Medicine Antwerp, Department of Clinical Sciences
Alberto Piubello, Damien Foundation/ The Union
Anita Mesic, Médecins Sans Frontières Operational Centre Amsterdam
Gunta Dravniece, KNCV Tuberculosis Foundation
Hans L Rieder, University of Zurich
Email Address: gvheusden@itg.be
Date Of Record Creation: 2017-10-22 16:23:24 (W3C-DTF)
Date Of Record Release: 2017-10-22 20:37:38 (W3C-DTF)
Date Record Checked: 2017-10-22 (W3C-DTF)
Date Last Modified: 2017-10-22 20:37:38 (W3C-DTF)

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