CORE Posters Fall 2025

Addressing Gaps in Rural Health: Upbringing in Endemic Areas as a Predictor of Provider Preparedness for Tick-Borne Illness Castle J, BS, Ellen C, BA, Grace D, BS, Hall J, EdD, Harbert-Harron H, BSN, Hughes L, MA, Stoneham M, BS, Nicholson J, MAT, Kadio B, MD, PhD, MPH

Edward Via College of Osteopathic Education, Preventive Medicine (Group M), Blacksburg, VA.

Methods and Next Steps

Introduction

Evidence on Gaps in Knowledge

• The objective of this study is to answer the question “Are providers who were raised in regions where tick-borne diseases are endemic more comfortable diagnosing them than providers raised in non-endemic areas?” • To evaluate this, a 16-question cross-sectional survey will be administered to collect participants demographic data in relation to confidence in recognizing and diagnosing tickborne illnesses. Our survey will contain general questions pertinent to the diagnoses of common tickborne illnesses in addition to asking participants to rate their confidence in their competency via Likert scale. Pending IRB approval, this survey will be distributed to medical students who are members of VCOM Virginia's Class of 2028. • Analysis of the data will allow us to examine the relationship between comfortability in diagnosing tick-borne illnesses and primary area of residence as an adolescent. We predict a decreased sense of comfortability in recognizing and diagnosing tickborne illnesses in students who did not live in an area endemic to tick-borne illness. • Addressing knowledge gaps regarding tick-borne diseases is essential for medical education in endemic regions. Integrating targeted training into medical education will ensure that future physicians in Virginia and the surrounding region are proficient in the timely recognition and management of these common and clinically significant conditions.

Tick-borne illnesses are a growing public health concern in Virginia due to rapidly increasing incidences of Lyme disease, Rocky Mountain Spotted Fever, and Ehrlichiosis. Studies indicate that climate change, expanding tick habitats, and increased human-tick interactions have contributed to the rise in cases. As tick populations continue to spread across the region, so does the risk of infection, underscoring the urgent need for enhanced disease recognition and management. Despite the increasing prevalence of tick-borne illnesses, many healthcare providers struggle with accurate diagnosis and treatment. Misdiagnosis remains an issue, leading to delayed or inadequate treatment that can result in complications. For example, Lyme disease, often presents with nonspecific symptoms such as fever, fatigue, and joint pain, and often mistaken for other viral infections, fibromyalgia, or autoimmune disorders. Similarly, Anaplasmosis and Ehrlichiosis share similar symptoms, making them prone to misclassification. Our study aims to assess the differences in medical student's knowledge of tick-borne disease based on the region that they resided in most of their adolescent years. By evaluating both how well medical students identify tick borne diseases as well as their self-reported diagnostic comfortability and personal history with tick-borne diseases, we expect to see a significant difference between medical students raised in tick-borne disease-endemic areas and those who were not. This will allow for more targeted education practices subsequently increasing provider knowledge, improving patient outcomes, and filling a significant gap in current literature.

Inadequate provider training in recognizing tick-borne diseases can lead to delayed diagnosis, prolonged illness, and unnecessary treatment. Geographic variation influences provider knowledge, as those without exposure to endemic regions may have greater difficulty identifying characteristic presentations and key symptoms.

Although individual diagnostic performance is difficult to predict, studies show that low prevalence conditions are often overlooked, leading to errors in recognition. Providers practicing in endemic regions who were trained in non endemic areas, may have an additional barrier to timely diagnosis and treatment which are both critical for reducing the severity and long-term consequences of tick borne diseases.

According to current research, providers in Canada who practice in endemic areas of tick-borne illness tend to be better at diagnosing and treating patients who present with these diseases in comparison to other healthcare providers who are practicing in non-endemic areas.

Providers who grew up in regions where tick-borne diseases are endemic may have greater confidence and diagnostic ability when encountering these conditions in practice.

References

1. Anina N. Rich, Melina A. Kunar, Michael J. Van Wert, Barbara Hidalgo-Sotelo, Todd S. Horowitz, Jeremy M. Wolfe; Why do we miss rare targets? Exploring the boundaries of the low prevalence effect. Journal of Vision 2008;8(15):15. https://doi.org/10.1167/8.15.15. 2. Centers for Disease Control and Prevention. Geographic distribution of tick-borne disease cases. CDC. 2025. https://www.cdc.gov/ticks/data-research/facts-stats/geographic-distribution-of-tickborne disease-cases.html 3. Eisen RJ, Eisen L. The blacklegged tick, Ixodes scapularis: An increasing public health concern. Trends Parasitol. 2018;34(5):465-476. 4. Ferrouillet C, Fortin É, Couillard M, Ouhoummane N, Milord F. Lyme disease: Knowledge and practices of family physicians in southern Quebec. Can Fam Physician. 2015;61(12):e565-e573. 5. Johnson L, Wilcox S, Mankoff J, Stricker RB. Severity of chronic Lyme disease compared to other chronic conditions: A quality of life survey. PeerJ. 2020;8:e10150. 6. Kobayashi T, Higgins Y, Samuels R, et al. Misdiagnosis of Lyme Disease With Unnecessary Antimicrobial Treatment Characterizes Patients Referred to an Academic Infectious Diseases Clinic. Open Forum Infect Dis. 2019;6(7):ofz299. doi:10.1093/ofid/ofz299 7. Kugeler KJ, Schwartz AM, Delorey MJ, Mead PS, Hinckley AF. Estimating the frequency of Lyme disease diagnoses, United States, 2010 – 2018. Emerg Infect Dis. 2021;27(2):616-619. 8. “Geographic Distribution of Tickborne Disease Cases.” Ticks: Data & Research, CDC, 6 Aug. 2025, www.cdc.gov/ticks/data-research/facts-stats/geographic-distribution-of-tickborne-disease-cases.html 9. VCOM 2019 Annual Report,” Edward Via College of Osteopathic Medicine , 2019, p. 20, VCOM 2019 Annual Report

Acknowledgements

Work made in collaboration with Radford University and Ticks in Virginia. Study currently pending approval by IRB.

Figure 1. CDC Surveillance Data for Tick Borne Illnesses

Figure 2 VCOM Students in Target Region