Caroline R. Paul, MD, Gwen C. McIntosh, MD, MPH, University of Wisconsin School of Medicine and Public Health, Madison, WI; Lori S. Weber, MD, University of Wisconsin School of Medicine and Public Health, LaCrosse, WI
Competency in pediatric otoscopy is critical to the diagnosis of acute otitis media. Acquiring this skill should begin in medical school. Our aim was to evaluate a curriculum in pediatric otoscopy for 3rd year medical students. A curriculum was implemented in a pediatric clerkship. Objectives focused on the approach to the ear exam and tympanic membrane findings. The instructional strategy was a 2 hour practical lab. After demonstrating a checklist (24 points), the lab instructor had students practice skills on themselves and on mannequins and gave facilitated feedback. Pre- and post-intervention written tests (25 points) assessed gains in knowledge and skill. The intervention was completed on 101 consecutive students. A subset of 41 students assigned to clinic sites performed ear exams on their patients. Their preceptors assessed their skills as per the checklist before and after the lab. Students in the intervention group (IG) completed a survey. A non-intervention group (NIG) (n=10) received the same measures. Paired t-tests were used to compare pre- and post- scores on written tests and checklists. ANCOVA tests were used to compare differences between the IG and NIG. Pre-intervention written test scores were similar (p=0.67) for the IG and NIG. There were differences between the pre- and post- written test scores for both groups. (IG mean pre 12.9, mean post 22.6; p<0.001, NIG mean pre 12.9, mean post 14.4; p=0.03). Gain scores were higher (p<0.001) in the IG than the NIG (mean gain 9.7 IG, mean gain 2.9 NIG). Pre-intervention checklist scores were similar (p= 0.07) for the IG and NIG. There was a difference (p<0.001) between the pre- and post-scores on the checklist for the IG (mean pre 10.9, mean post 19.2; p<0.001) and no difference for the NIG (mean pre 8.2, mean post 11.3; p=0.13). Gain scores were higher (p=0.004) in the IG than the NIG (mean gain of 8.3 for IG, 2.9 for NIG). 90% of the IG desired that their preceptors observe their otoscopic skills. This curriculum demonstrated gains in knowledge and skill including skill observed with real patients. The curriculum’s instructional strategy and measures with real patients and clinical settings can be generalized to other clinical topics.