CAROLINE R PAUL, MD - UNIVERSITY OF WISCONSIN SCHOOL OF MEDICINE AND PUBLIC HEALTH; Gwen C McIntosh, MD, MPH - University of Wisconsin School of Medicine and Public Health; Craig L Gjerde, PhD - University of Wisconsin
Objective: Pediatric otoscopy training begins in medical school. We aim to evaluate a curriculum for third-year students.
Methods: A curriculum was implemented during the pediatric clerkship from 2009-11. An intervention group (IG) of 100 students received a lab which included a skills checklist demonstration and allowed students to practice skills on each other and mannequins with facilitated feedback. Pre-intervention (pre-I) and post-intervention (post-I) written tests assessed gains in knowledge and skills for the IG and a non-intervention group (NIG) of 30 students. The NIG and subset of 53 students in the IG performed ear exams on real clinic patients. Their preceptors assessed them with the checklist before and after the lab. At the end of their fourth year, 79 students in the 2009-2010 IG received a survey and a retention test containing the same items they received during the curriculum. Paired t-tests were used to compare pre-I, post-I, and retention scores. ANCOVA tests were used to compare differences between the IG and NIG.
Results: Pre-I scores for the written test and checklist were similar (p=0.45-0.88) for both groups (IG and NIG mean=12.9 for test; IG mean=11.0, NIG mean=10.9 for checklist). Post-I scores were significantly higher (p<0.001) for the IG (mean=22.5 for test; 19.1 for checklist) than the NIG (mean=13.9 for test; mean=11.0 for checklist). Gain scores were significantly higher (p<0.001) for the IG (mean=9.6 for test; mean=8.1 for checklist) than in NIG (mean=1.0 for test; mean=-0.1 for checklist).
There was a significant decrease (p<0.001) from the post-I scores to the retention scores (mean=-6.88) but a significant increase (p<0.001) from the pre-I score to the retention score (mean overall gain=2.6). 60% and 68% of students respectively reported no further knowledge or skill gain after their clerkship. 82% desired preceptor observation of their skills. 87% rated their skills at or above average.
Discussion: Measures including those using real patients indicate that this curriculum translated lab learning into short-term bedside learning. Yet, gains were not fully sustained. Gains attained during clerkships need to be reinforced and reassessed continually especially for critically required skills.