Council on Medical Student Education in Pediatrics

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COMSEP 2011 San Diego Meeting with AMSPDC

Poster Presentation:


IMPACT OF A TELEPHONE TRIAGE CURRICULUM IN THE 3RD YEAR PEDIATRIC CLERKSHIP

Authors:
Julie M. Noffsinger, MD, Jennifer B. Soep, MD, University of Colorado Denver, Aurora, CO; Carol S. Hodgson, PhD, University of Alberta, Edmunton, Alberta,

Background:  Telephone triage is an important skill for practicing physicians; however students rarely receive formal training in this area. A telephone encounter is included in the objective structured clinical exam (OSCE) given at the end of the 3rd-year curriculum at the University of Colorado Denver (UCD) and in the USMLE Step II Clinical Skills Exam. We implemented a telephone triage curriculum within the pediatric clerkship which included a didactic session, cases, and role playing. Research questions were: (1) Does receiving the triage curriculum improve student performance on a telephone triage standardized patient (SP) case? and (2) How satisfied are students who complete a telephone triage curriculum? Methods: Subjects were 3rd-year students at UCD in 2 consecutive cohorts (no curriculum, n=152; completed curriculum, n=145). The SP checklist item-level scores of the OSCE triage case were the performance outcome measures. A 3-item curriculum evaluation with a 4-point scale and a post-OSCE survey were used to measure student attitudes. Results: Students from both cohorts performed well on the case, with only small mean differences on the item scores between the two groups. However, only students completing the curriculum asked the caregiver to measure the child’s heart rate to assess hydration status, a necessary component of the case that was taught during the didactic session. Students rated the triage curriculum as good/very good on appropriateness (93%), quality of group discussion (96%), and overall teaching (99%). Based on the post-OSCE survey, 65% of the curriculum-group students reported their preparation being mostly/extremely effective for the case compared to 45% of students in the non-curriculum group. Discussion: Both groups of students performed equally well on the telephone triage case, but the curriculum group felt more prepared. While there was a suggestion that students incorporated techniques taught (i.e., heart rate), our checklist items may not have been specific enough to measure curricular impact or may measure general history taking skills. Improvements could be made to the checklist to align our assessment tool with curricular learning objectives. In addition, incorporating more skills practice could help students feel more prepared.