Abstract
BackgroundThe serious consequences of inaccurate diagnosis of acute otitis media have led to a call for greater education to develop proficient pediatric otoscopy skills. Despite the clinical and educational needs, peer-reviewed standardized curricula with validated assessment instruments remain limited. This study evaluated a pediatric otoscopy curriculum incorporated into the Pediatric medical student clerkship with use of outcome measures that included assessment of skills with real patients. The objective was to determine whether students who received the intervention would demonstrate significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure.MethodsDuring their Pediatric clerkship, an intervention group (IG) of 100 medical students received routine instruction and a curriculum intervention. A non-intervention group (NIG) of 30 students received only routine instruction. Outcome measures included written tests and assessment of skills with real patients. A retention group (RG) consisted of 79 students in the IG who completed a written test at the end of medical school. Paired t-tests were used to compare differences in pre-intervention, post-intervention, and retention scores for the IG, NIG, and RG, while analysis of covariance tests were used to compare differences in scores between the IG and NIG.ResultsPre-intervention scores were similar for the IG and NIG for the written test (mean/SD of 12.9/2.9 for IG and 12.9/1.8 for NIG, p = 0.78) and skills checklist (mean/SD of 11.1/4.4 for IG and 10.9/4.0 for NIG, p = 0.88). The IG had significantly higher post-intervention scores than the NIG for the written test (mean/SD of 22.6/1.7 for IG and 13.9/2.5 for NIG, p < 0.001) and skills checklist (mean/SD of 19.2/3.4 for IG and 11.0/3.8 for NIG, p < 0.001). The IG also had significantly higher gain in scores than the NIG for the written test (mean/SD +9.6/2.8 for IG and +1.0/2.3 for NIG, p < 0.001) and skills checklist (mean/SD of +8.1/4.8 for IG and +0.1/4.5 for NIG, p < 0.001). For the RG, there was a significant decrease (p < 0.001) from the post-intervention scores to retention scores (mean/SD of −7.4/2.7) but a significant increase (p < 0.001) from the pre-intervention score to retention score (mean + 2.6/3.3).ConclusionsMedical students who received a formal curriculum intervention demonstrated significant gains in pediatric otoscopy skills when compared with students with only routine immersion learning exposure. However, learning gains diminished over time, emphasizing the need for continued practice opportunities to reinforce students’ skills. Our study provides a formal curriculum to meet identified educational gaps in the important topic of pediatric otoscopy and offers a model for teaching of other clinical skills using rigorous outcome measures including assessment of skills in real patients.
Highlights
The serious consequences of inaccurate diagnosis of acute otitis media have led to a call for greater education to develop proficient pediatric otoscopy skills
Diagnostic uncertainty due to a lack of pediatric otoscopy skills has led to an overdiagnosis of Acute otitis media (AOM), which has resulted in an increased incidence of antimicrobial resistance and higher healthcare costs due to unnecessary antibiotic prescriptions and surgical referrals [5]
While the topic of AOM is prevalent in the learning realm of the medical student, students report that their confidence at arriving at an accurate diagnosis of AOM is low [11]. To meet this educational gap with the overarching aim to impact patient care by improving the accuracy of diagnosing AOM, we evaluated a curriculum for pediatric otoscopy incorporated into the Pediatric medical student clerkship with the use of outcome measures that included assessment of skills with real patients
Summary
The serious consequences of inaccurate diagnosis of acute otitis media have led to a call for greater education to develop proficient pediatric otoscopy skills. Acute otitis media (AOM) is the most frequently diagnosed illness in children. Otitis media with effusion (OME), a condition often misdiagnosed as AOM and which does not require antibiotics, is the most common condition for which antibacterial agents are prescribed [5]. Proficient skills in pediatric otoscopy is critical for making an accurate diagnosis of AOM as the condition is confirmed by the identification of an effusion and acute inflammatory changes in the middle ear. Diagnostic uncertainty due to a lack of pediatric otoscopy skills has led to an overdiagnosis of AOM, which has resulted in an increased incidence of antimicrobial resistance and higher healthcare costs due to unnecessary antibiotic prescriptions and surgical referrals [5]
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