Abstract
Physicians underrecognize and undertreat anaphylaxis. Effective interventions are needed to improve physician knowledge and competency regarding evidence-based anaphylaxis diagnosis and management (ADAM). We designed and evaluated an educational program to improve ADAM in pediatrics, internal medicine, and emergency medicine residents from two academic medical centers. Anonymous questionnaires queried participants' demographics, prior ADAM clinical experience, competency, and comfort. A pretest assessing baseline knowledge preceded a 45-minute allergist-led evidence-based presentation, including practice with epinephrine autoinjectors, immediately followed by a posttest. A follow-up test assessed long-term knowledge retention twelve weeks later. 159 residents participated in the pretest, 152 participated in the posttest, and 86 participated in the follow-up test. There were no significant differences by specialty or site. With a possible score of 10, the mean pretest score (7.31 ± 1.50) was lower than the posttest score (8.79 ± 1.29) and follow-up score (8.17 ± 1.72) (P < 0.001 for both). Although participants' perceived confidence in diagnosing or managing anaphylaxis improved from baseline to follow-up (P < 0.001 for both), participants' self-reported clinical experience with ADAM or autoinjector use was unchanged. Allergist-led face-to-face educational intervention improves residents' short-term knowledge and perceived confidence in ADAM. Limited clinical experience or reinforcement contributes to the observed decreased knowledge.
Highlights
Teaching physicians effectively about low probability, high consequence medical conditions, such as anaphylaxis, is challenging
We developed, implemented, and evaluated an educational program consisting of face-to-face didactic session and hands-on training conducted by allergy trainees or attending physicians in the proper use of epinephrine autoinjectors
Since chi-squared analysis failed to reveal a significant difference by site (P = 0.86) or by specialty (P = 0.95) over time, data were combined in subsequent analyses
Summary
Teaching physicians effectively about low probability, high consequence medical conditions, such as anaphylaxis, is challenging. Medical education curricula emphasize more common high stakes conditions (e.g., stroke) where misdiagnosis or mismanagement leads to poor outcomes. Physicians may lack opportunities to gain firsthand clinical experience or to reinforce their limited learning of infrequent conditions. Clinicians face several challenges when dealing with anaphylaxis, a potentially life-threatening allergic reaction requiring immediate identification and treatment. There are no universally accepted diagnostic criteria for anaphylaxis [1, 2]. A comprehensive clinical definition of anaphylaxis from an NIH expert panel has not achieved widespread acceptance among physicians despite high reported sensitivity and negative predictive value [1, 3, 4]. There are no pathognomonic anaphylaxis signs or symptoms.
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