Caroline R. Paul, MD, MD, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, Gregory S. Rebella, MD, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, Meg G. Keeley, MD, University of Virginia School of Medicine, Charlottesville, VA
Background: The AAP/AAFP guidelines recommend that “instruction in the proper examination of the child’s ear should begin with the first pediatric rotation in medical school and continue throughout postgraduate training.” However, competency-based curricula for all learners remain limited.
Objective: For the purpose of curriculum development, a needs assessment for Pediatric Residency Interns (PI) and Emergency Medicine Residency Interns (EMI) was performed at the beginning and end of internship to identity learning needs for pediatric otoscopy including any similarities between groups of learners.
Methods: All PI (n=14) and EMI (n=6) were assessed at the beginning and end of internship with a written test which included validated images (Pediatrics, 2009) and an OSCE which evaluated technique, cerumen removal, and pneumatic otoscopy using a validated ear model (Simulation in Healthcare, 2011). A subset of PI (n=5) were also assessed with real patients using a developed checklist (Paul C. COMSEP, 2011) Two-sample t-tests were used to compare mean scores and minimum passing levels (MPL).
Results: There was no significant difference between PI and EMI in pre-intern mean written test scores (19.9 vs. 21.0; p=0.66) or pre-intern mean OSCE scores (21.4 vs. 24.0; p=0.25). For the combined group (CG) of PI and EMI, 38% and 56% achieved MPL on pre-intern and post-intern written test respectively, while no intern achieved MPL on pre-intern or post-intern OSCE. Mean gains for written test were 3% for CG (p=0.27), 3% for PI (p=0.28), and 1% for EMI (p=0.87), while mean gains for OSCE were -5% for CG (p=0.04), -3% for PI (p=0.60), and -6% for EMI (p=0.04). Mean gains were not significantly different between PI and EMI for written test (p=0.75) or OSCE (p=0.61). Mean gain for PI assessed with real patients was 1.8 (p=0.6).
Conclusions: Pre-intern assessment similarities amongst graduating medical students indicate that competency cannot be assumed per residency choice. Post-intern assessments indicate existing intern training is not sufficient. Skills regression can occur despite intern year completion. Direly needed competency–based interventions should focus on identified deficits and have broader applicability to learners of various specialties and experience levels.