Spirometry testing education in medical schools: a missed opportunity?

Yawn, Barbara P.; Yawn, Roy A.

doi:10.1016/j.pcrj.2004.10.003

Cited by 7 publications

(6 citation statements)

References 21 publications

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“…6 Other studies have shown that medical students do not receive sufficient training in the interpretation of PFTs or in the diagnosis of COPD. 15–17 In our study, even though the GOLD guidelines were first published more than a decade ago, less than half of respondents were aware of their existence and even fewer had read them. Hence, there may need to be greater resources dedicated to increasing awareness of the GOLD guidelines.…”

Section: Discussionmentioning

confidence: 60%

Barriers to adherence to COPD guidelines among primary care providers

Pérez

Wisnivesky

Lurslurchachai

et al. 2012

Respiratory Medicine

141

124

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Background Despite efforts to disseminate guidelines for managing chronic obstructive pulmonary disease (COPD), adherence to COPD guidelines remains suboptimal. Barriers to adhering to guidelines remain poorly understood. Methods Clinicians from two general medicine practices in New York City were surveyed to identify barriers to implementing seven recommendations from the Global Initiative for Chronic Obstructive Lung Disease (GOLD) guidelines. Barriers assessed included unfamiliarity, disagreement, low perceived benefit, low self-efficacy, and time constraints. Exact conditional regression was used to identify barriers independently associated with non-adherence. Results The survey was completed by 154 clinicians. Adherence was lowest to referring patients with a forced expiratory volume in one second (FEV1) <80% predicted to pulmonary rehabilitation (5%); using FEV1 to guide management (12%); and ordering pulmonary function tests (PFTs) in smokers (17%). Adherence was intermediate to prescribing inhaled corticosteroids when FEV1 <50% predicted (41%) and long-acting bronchodilators when FEV1 <80% predicted (54%). Adherence was highest for influenza vaccination (90%) and smoking cessation counseling (91%). In unadjusted analyses, low familiarity with the guidelines, low self-efficacy, and time constraints were significantly associated with non-adherence to ≥2 recommendations. In adjusted analyses, low self-efficacy was associated with less adherence to prescribing inhaled corticosteroids (OR: 0.28; 95% CI: 0.10, 0.74) and time constraints were associated with less adherence to ordering PFTs in smokers (OR: 0.31; 95% CI: 0.08, 0.99). Conclusions Poor familiarity with recommendations, low self-efficacy, and time constraints are important barriers to adherence to COPD guidelines. This information can be used to develop tailored interventions to improve guideline adherence.

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Section: Discussionmentioning

confidence: 60%

Barriers to adherence to COPD guidelines among primary care providers

Pérez

Wisnivesky

Lurslurchachai

et al. 2012

Respiratory Medicine

141

124

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show abstract

“…Training related to COPD and its diagnosis through use of pre- and post-bronchodilator spirometry testing should begin in medical school (Yawn and Yawn 2005) and be supplemented in residency training and in continuing medical education. Physicians who had completed training within the past 15 years were no more likely than those completing training more than 15 year ago to report use of spirometry or reversibility testing to diagnose COPD, which suggests that more recent training is still not addressing this issue sufficiently.…”

Section: Discussionmentioning

confidence: 99%

Knowledge and attitudes of family physicians coming to COPD continuing medical education

Yawn

Wollan²

2008

COPD

113

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PurposeCOPD remains under-recognized and under-treated. Much of early COPD care is given by primary care physicians but only when COPD is recognized. This survey explores the attitudes, beliefs, and knowledge related to COPD recognition, diagnosis, and treatment from family physicians and nurse practitioners (NPs) and physician assistants (PAs) working in primary care.MethodsWe completed a survey of family physicians, and NPs/PAs attending one of three CME programs on five common chronic conditions including COPD.ResultsReturn rate was 62% (n = 284) including 178 physicians and 100 NPs/PAs. Fewer than half of the respondents reported knowledge of or use of COPD guidelines. The barriers to recognition and diagnosis of COPD they reported included the multiple morbidities of most COPD patients, failure of patients to report COPD symptoms, as well as lack of knowledge and inadequate training in COPD diagnosis and management. Three quarters (74%) of respondents reported use of spirometry to diagnose COPD but only 32% said they included reversibility assessment. COPD was incorrectly assessed as a disease primarily of men (78% of respondents) that appeared after age 60 (61%). Few respondents reported that they believed COPD treatment was useful or very useful for improving symptoms (15%) or decreasing exacerbations (3%) or that pulmonary rehabilitation was helpful (3%), but 13% reported they thought COPD treatment could extend longevity.ConclusionsPrimary care physicians and NPs/PAs working in primary care continue to report lack of awareness and use of COPD guidelines, as well as correct information related to COPD epidemiology or potential benefits of available treatments including pulmonary rehabilitation. It is unlikely that diagnosis and management of COPD will improve in primary care until these knowledge gaps and discrepancies with published efficacy of therapy issues are addressed.

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“…Despite this, published evidence suggests that spirometry is under-used both in primary care and hospital settings and is also poorly understood by clinical trainees [ 4 - 8 ]. In addition, a recent review of the literature has highlighted the apparent rarity of teaching on pulmonary function testing in undergraduate curricula [ 9 ].…”

Section: Introductionmentioning

confidence: 99%

Comparison of a web-based package with tutor-based methods of teaching respiratory medicine: subjective and objective evaluations

2007

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Background: Respiratory disease is a major cause of morbidity and mortality not only in the United Kingdom, but globally. A good understanding of respiratory disease and its treatment is essential for all medical graduates. As a result of changes in clinical practice, patients with some common respiratory illnesses are less often admitted to hospital, restricting the experience available to undergraduate students. Combined with a potential shortage of clinical teachers, this means that new methods of teaching need to be developed and appraised. The aim of this study was to establish whether a web-based package on the diagnosis of respiratory disease would be as effective and as acceptable to final year medical students as tutor-led methods of teaching the same material.

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Spirometry testing education in medical schools: a missed opportunity?

Cited by 7 publications

References 21 publications

Barriers to adherence to COPD guidelines among primary care providers

Barriers to adherence to COPD guidelines among primary care providers

Knowledge and attitudes of family physicians coming to COPD continuing medical education

Comparison of a web-based package with tutor-based methods of teaching respiratory medicine: subjective and objective evaluations

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