Recognition of Category A bioterrorism agent syndromes by final-year medical students in the UK: a pilot study

Background Early recognition of presentations consistent with the deliberate release of a Category A bioterrorism agent is essential for rapid isolation, public health notification, and containment. The ability of UK clinicians-in-training to recognise these syndromes is unstudied. This pilot assessed final-year UK medical students' ability to recognise these syndromes. Methods A pilot cross-sectional online survey of final-year UK medical students used single-best-answer clinical vignettes depicting syndromes associated with Category A bioterrorism agents (BT vignettes) and clinically overlapping non-bioterrorism syndromes (NBT vignettes). Performance was summarised as the proportion of vignettes correctly identified, with primary analysis comparing within-participant BT and NBT performance. Results Twenty-five participants completed the survey. Participants performed worse on BT vignettes (M = 0.55) than on NBT vignettes (M = 0.81), with a within-participant difference of -0.26 (95% CI [-0.35, -0.18]; t(24) = -6.33, p < 0.001; Cohen's dz = -1.27). Botulism (96.0%) and Ebola virus disease (88.0%) were recognised by most participants, while anthrax (40.0%), pneumonic plague (28.0%), and smallpox (24.0%) were recognised by fewer than half. Conclusion This pilot provides the first UK evidence of a substantial diagnostic deficit in final-year medical students' recognition of Category A bioterrorism agent syndromes.