Celiac Disease in Medical Curriculum

Introduction:  Celiac disease is a common autoimmune illness precipitated by the ingestion of gluten, a protein contained in grains (e.g., wheat, barley, and rye).  Celiac disease can present with a wide variety of manifestations across nearly any body system, but most individuals with celiac disease present with subclinical symptoms.  Despite relatively inexpensive testing and an effective treatment (i.e., a gluten free diet), most individuals with celiac disease remain undiagnosed, leading to significant disease burden.  Research suggests that physicians have poor knowledge of celiac disease, likely contributing to the high rates of missed diagnoses.  This study sought to assess the information encountered by students in pre-clinical medical education regarding celiac disease. Methods:  Information was drawn from recent literature to create a rubric to evaluate the presentation of celiac disease in curricular and educational resources for pre-clinical medical students.  Categories evaluated included prevalence, morbidity/mortality, manifestations, comorbidities, and testing recommendations.  This rubric was used to assess the curriculum from a large US medical school and First Aid for the USMLE Step 1, a popular commercial resource used by medical students. Results:  The medical school curriculum scored higher overall than First Aid (31/48 and 12/48, respectively).  The curriculum also scored higher in all categories except morbidity/mortality.  The curriculum showed deficits predominantly in morbidity/mortality and testing recommendations.  First Aid showed deficits in all categories. Discussion:  Results showed that the medical school curriculum provided more complete information about several aspects of celiac disease.  First Aid did not thoroughly address any of the categories evaluated with the rubric.  While First Aid may be an effective consolidation of Step 1 material, it seems likely that it is focused on “teaching to the test” rather than providing thorough medical education for future physicians.  The medical curriculum is a more complete resource for students to learn about celiac disease.