Teaching the pediatric ear exam and diagnosis of Acute Otitis Media: a teaching and assessment model in three groups

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.Electronic supplementary materialThe online version of this article (10.1186/s12909-017-0988-y) contains supplementary material, which is available to ...

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

“…Critical learning opportunities were missed, with students reporting inadequate observation of their exam technique and few supervising physicians providing feedback on students' skills. 4 Given the critical teaching role of pediatric preceptors, it is important to understand preceptor practice and teaching patterns and their use of existing curricula and AAP Guidelines in teaching otoscopy. Currently, little is known about preceptors' own otoscopy skills, their teaching needs, and their perceptions and attitudes toward teaching pediatric otoscopy to medical students.…”

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

“…1 The threat of rising healthcare costs, growing antibiotic resistance, and increased surgical referrals for recurrent AOM combine to make the accurate diagnosis of AOM important. 1,[3][4][5] Competency in the pediatric ear exam is critical to the accurate diagnosis and appropriate management of pediatric ear disease. 1,3 The American Academy of Pediatrics (AAP) 2013 Clinical Practice Guidelines stresses that diagnosis of AOM relies on adequate visualization of the tympanic membrane, 1 a clinical skill acquired through a deliberate, stepwise approach.…”

“…1,3 The American Academy of Pediatrics (AAP) 2013 Clinical Practice Guidelines stresses that diagnosis of AOM relies on adequate visualization of the tympanic membrane, 1 a clinical skill acquired through a deliberate, stepwise approach. 4,6 The AAP recommends that instruction in the evaluation of the middle ear begin "in medical school and continue throughout postgraduate training." 1 Especially given that physicians other than pediatricians will diagnose children with AOM, delivering standardized otoscopy curricula to trainees in medical school is "an absolute necessity" for "the most widespread effect" on clinical practice.…”

“…7 Despite expert recommendations, peer-reviewed curricula in pediatric otoscopy have emerged only recently. 4,6,8,9 Such curricula have demonstrated gains in knowledge and skills that translate to the clinical setting. 3,4 However, their actual use in clinical teaching is unknown and relies on the individual faculty responsible for teaching pediatric otoscopy.…”

“…4,6,8,9 Such curricula have demonstrated gains in knowledge and skills that translate to the clinical setting. 3,4 However, their actual use in clinical teaching is unknown and relies on the individual faculty responsible for teaching pediatric otoscopy. In addition to peer-reviewed curricula, advances in technology, such as digital video otoscopes to improve visualization of the tympanic membrane, have emerged.…”