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Competency gaps in pediatric tuberculosis care and priorities for continuing education: Evidence from a national
Aole Li1, Juanjuan Liu1, Yuhang Wu1
1Department of Infectious Disease, Children's Hospital, Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou, China.
Insights
Physician knowledge of pediatric tuberculosis (TB) in China is insufficient, with significant gaps in practical clinical areas. Targeted, case-based continuing medical education (CME) is needed to improve early detection and care.
Area of Science:
- Pediatrics
- Infectious Diseases
- Public Health
Background:
- Pediatric tuberculosis (TB) recognition relies on frontline healthcare workers.
- Pediatric TB is under-recognized in China, with limited understanding of physician knowledge across settings.
- Improving physician knowledge is crucial for enhancing TB services and continuing medical education (CME).
Purpose of the Study:
- To assess the knowledge and attitudes of physicians toward pediatric TB in China.
- To identify gaps in understanding and factors associated with knowledge levels.
- To inform improvements in CME and pediatric TB care strategies.
Main Methods:
- A national, multicenter, cross-sectional survey was conducted from 2021-2022.
- A 20-item questionnaire based on WHO Module 5 assessed pediatric TB knowledge among physicians.
- Subgroup comparisons and multivariable logistic regression analyzed associated factors, defining adequate knowledge as ≥6/10.
Main Results:
- Only 35.6% of 2202 physicians demonstrated adequate knowledge of pediatric TB.
- Significant knowledge gaps were observed in tuberculin skin testing, treatment regimens, and screening triggers.
- Knowledge varied by practice experience, region, and prior exposure; physicians in central China showed higher adequate knowledge.
Conclusions:
- Practical knowledge deficits persist among Chinese physicians regarding pediatric TB care.
- Current lecture-based CME may be insufficient; practical, case-based training is recommended.
- Enhanced training in diagnostics, contact tracing, and case management can improve early detection and care consistency.
Background:
Early recognition of pediatric tuberculosis (TB) depends on frontline healthcare workers' ability to identify suspected cases. In China, pediatric TB is often under-recognized, and little is known about how physicians from different specialties and healthcare settings understand the disease. Understanding these gaps is important in improving continuing medical education (CME) and strengthening pediatric TB services.
Methods:
We conducted a national, multicenter, cross-sectional survey from 2021 to 2022 using a 20-item questionnaire based on the WHO Module 5 to assess knowledge and attitudes toward pediatric TB among physicians across different regions and hospital levels. Adequate knowledge was defined as a score of ≥ 6/10. Subgroup comparisons and multivariable logistic regression were used to examine associated factors.
Results:
Overall, 35.6% of the 2202 participants had adequate knowledge. Gaps were found in areas relevant to routine clinical practice, including the timing of repeat tuberculin skin testing (41.3%), selection of the standard six-month treatment regimen (56.6%), and recognition of symptom-based screening triggers (32.0%). Knowledge levels varied according to years of practice, region, prior exposure to pediatric TB cases, and attitudes toward invasive diagnostic procedures. Physicians in central China had higher odds of adequate knowledge than those in eastern China (OR 1.24; 95% CI, 1.01-1.54). No significant differences were found by department or professional title, although variation across specialties was noted.
Conclusions:
Practical knowledge gaps remain among physicians in pediatric TB care. These gaps may require moving beyond traditional lecture-based CME toward more practical, case-based activities that better reflect clinical practice. Enhancing training in diagnostic procedures, contact investigation, and case-based management may help improve early detection and consistency of care in China and may also be relevant to other high-burden settings.
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