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Appendices  

Appendix A: Promoting Quality in the Practice of Travel Medicine

Calvin Patimeteeporn, Stephen M. Ostroff

Travel medicine remains a young area of medical practice, but even as the field continues to mature based on a growing body of scientific and medical information, there remains no recognized specialty or subspecialty of travel medicine anywhere in the world, including the United States. Clinicians offering travel medicine services are not “board certified” in travel medicine. Instead, travel medicine providers generally have credentials in other disciplines, including infectious diseases, internal medicine, pediatrics, nursing, pharmacy, or family practice. Clinics in the United States that offer travel medicine services are also not specifically credentialed for this purpose.

Given these circumstances, how can travelers maximize the likelihood their provider will deliver quality travel-related medical care and that the advice, preventive measures, and treatment services they are given fall within accepted standards? Similarly, how can providers assure patients they have sufficient knowledge of the subject matter relevant to travel medicine?

Research into the quality of travel health care is limited, but several studies suggest that travelers who visit a clinician with training in travel medicine are more likely to receive pretravel and post-travel advice and care than if they see other clinicians for such services. Similarly, 2006 guidelines on travel medicine published by the Infectious Diseases Society of America recommend that pretravel and post-travel care be obtained from a clinician with expertise in travel medicine. This is especially relevant for travelers going to exotic destinations, engaging in adventure travel, or who have special needs or medical problems.

Providers can pursue training in travel medicine through a number of professional organizations. Providers may also look to the many open and excellent courses hosted by members of the International Society of Travel Medicine (ISTM), notably those in the United States, Canada, Ireland, Scotland, and Switzerland. They vary in length from days to a year, depending upon the depth of the course and credential offered. Many individuals looking for training beyond the textbook do so informally by spending time in a travel clinic learning the basics of the pretravel consultation. Post-travel care typically involves infectious disease and tropical medicine training.

Below is a partial list of resources for clinicians who wish to enhance their knowledge of travel medicine. People seeking travel-related medical services may want to inquire whether their provider or clinic participates in these organizations or activities.

TRAVEL MEDICINE–RELATED PROFESSIONAL ORGANIZATIONS

International Society of Travel Medicine (ISTM)

Founded in 1991, ISTM (www.istm.org) is the preeminent multinational organization dealing exclusively with travel medicine. ISTM has >3,500 members worldwide.

ISTM activities include the following:

  • Journal of Travel Medicine
  • An active listserv (TravelMed) where members share information and can ask questions
  • Special-interest groups that include travel medicine nurses and travel medicine pharmacists
  • A biennial travel medicine meeting and annual regional submeetings
  • A directory of domestic and international travel clinics affiliated with ISTM members in 65 countries
  • An online learning curriculum of >60 programs that cover a wide range of topics and webinars on selected topics
  • ISTM Travel Medicine Continuing Professional Development Program
  • An examination leading to a Certificate of Knowledge in Travel Medicine, available to physicians, nurses, pharmacists, and other professionals offering travel advice

The ISTM Body of Knowledge, which covers the scope of the specialty of travel medicine, forms the basis for Certificate of Knowledge in Travel Medicine examination questions. It is regularly updated by the ISTM Exam Committee. Content areas in the Body of Knowledge include the following:

  • Epidemiology related to travel medicine
  • Immunology and vaccinology (including travel-related vaccines)
    • Pretravel consultation and management
    • Patient evaluation
    • Travelers with special needs
    • Special itineraries
    • Prevention and self-treatment
    • Precautions
  • Diseases contracted during travel
    • Vectorborne diseases
    • Diseases transmitted from person to person
    • Foodborne and waterborne diseases
    • Diseases related to bites and stings
    • Diseases due to environmental hazards
  • Other conditions associated with travel
    • Conditions occurring during or after travel
    • Conditions due to environmental factors
    • Threats to personal safety and security
    • Psychocultural issues
  • Post-travel management
  • General travel medicine issues
    • Medical care abroad
    • Travel clinic management
    • Travel medicine information resources

The Certificate of Knowledge in Travel Medicine examination has been administered since 2003, and as of 2016 more than 3,500 exams have been administered. The society hosts periodic 2-day intensive exam preparation courses open to all qualified professionals (such as physicians, nurses, pharmacists, and physician assistants) who provide travel health–related services. Those who are successful in the examination are awarded a Certificate in Travel Health (CTH). Beginning with CTHs awarded in 2011, the certificate is good for 10 years and the awardee must be recertified either through professional development activities or by retaking the examination. Practitioners offering travel medicine services or interested in the subject should strongly consider membership in ISTM. ISTM practitioners are listed on the organization’s website, and those who have the CTH are designated as such.

ISTM also offers research programs. These include research grants, travel awards, and support for such efforts as the GeoSentinel Surveillance Network.

American Society of Tropical Medicine and Hygiene (ASTMH)

Formed in 1951 through the merger of predecessor organizations dating back to 1903, ASTMH (www.astmh.org) has a subsection that deals exclusively with tropical and travel medicine, known as the American Committee on Clinical Tropical Medicine and Travelers’ Health.

ASTMH activities include the following:

  • The American Journal of Tropical Medicine and Hygiene
  • An annual meeting
  • An electronic distribution list
  • A tropical and travel medicine consultant directory
  • A biennial examination leading to a Certificate of Knowledge in Clinical Tropical Medicine and Travelers’ Health, available to those with a current professional health care license and who have passed an ASTMH-approved tropical medicine diploma course or have sufficient tropical medicine experience

The content areas of the ASTMH Certificate of Knowledge in Clinical Tropic Medicine and Travelers’ Health are as follows:

  • Basic science and fundamentals
  • Infectious and tropical diseases (including parasites, bacteria, fungi, and viruses)
  • Other diseases and conditions
  • Diagnostic and therapeutic approach to clinical syndromes
  • Travelers’ health
  • Public health in the tropics
  • Epidemiology and control of disease
  • Laboratory diagnosis

More than 750 people who have passed the ASTMH examination are listed on the ASTMH website. The society offers an annual intensive update course in clinical tropical medicine and travelers’ health, which is in part designed to prepare those planning to take the Certificate of Knowledge examination.

Wilderness Medical Society

Organized in 1983, this society (www.wms.org) focuses on adventure travel, including wilderness travel and diving medicine. Its activities include the following:

  • The journal Wilderness and Environmental Medicine
  • Practice guidelines for emergency care in wilderness settings
  • Annual meetings, a world congress, and subspecialty meetings
  • Courses leading to certification in advanced wilderness life support
  • Participation in courses that lead to a diploma in mountain medicine
  • A wilderness medical curriculum that, when successfully completed, qualifies members for fellowship in the Academy of Wilderness Medicine

Infectious Diseases Society of America (IDSA)

IDSA (www.idsociety.org) is the largest organization representing infectious disease clinicians in the United States. Although IDSA deals with all infectious diseases, it has many active members with expertise in tropical and travel medicine or strong interests in these disciplines. In 2006, IDSA published extensive evidence-based guidelines on the practice of travel medicine in the United States. IDSA also publishes travel-related research in its journals: The Journal of Infectious Diseases, Clinical Infectious Diseases, and Open Forum Infectious Diseases.

International Society for Infectious Diseases (ISID)

ISID (isid.org) was formed in 1986 and has approximately 60,000 members in 155 countries around the world. Like IDSA, ISID does not specifically focus on travel medicine. However, its international reach, particularly in low-resource countries, makes travel medicine an important topic in ISID and a valuable source of information for infectious diseases clinicians in many overseas travel destinations. Activities relevant to travel medicine that are supported by ISID include the following:

  • International Journal of Infectious Diseases
  • The biennial meeting International Congress on Infectious Diseases
  • The Program for Monitoring Emerging Diseases (Pro-MED), an open-source electronic reporting system for reports of emerging infectious diseases and toxins, including outbreaks (www.promedmail.org)

Aerospace Medical AssociationThis organization (www.asma.org) represents professionals in the fields of aviation, space, and environmental medicine who deal with air and space travelers. Its activities include the following:

  • The journal Aviation, Space, and Environmental Medicine
  • An annual meeting
  • Continuing medical education in topics related to aerospace medicine

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