S Andrew Josephson1, Leslie A Gillum. 1. Department of Neurology, University of California, San Francisco, California 94143-0114, USA. ajosephson@memory.ucsf.edu
Abstract
BACKGROUND: Methods of teaching neurologic examination skills are understudied compared with general physical examination skills. Eliciting an ankle reflex is an important element of a screening neurologic examination and directly drives further patient evaluation, but many students and physicians perceive this skill to be difficult; as a result, ankle reflex testing is frequently incorrectly performed or omitted entirely. METHODS:Twenty-two medical student volunteers of various levels of training took part in a blinded, randomized study of a brief intervention used to teach how best to elicit ankle reflexes. Standardized patients were used with quantification of ankle reflexes using electrodiagnostic techniques, providing an objective gold standard. RESULTS: Both the control and intervention groups improved over the course of the trial with mean change scores for correctness (maximum = 6) significantly increasing from 2.68 +/- 1.5 to 4.23 +/- 1.2 (P = 0.003) before and after the training sessions. However, there was no difference in change scores between students receiving the intervention and those in the control group in the entire cohort (P = 1.0) or by year. In a multivariate model, no significant difference in change score was associated with the intervention teaching session. CONCLUSIONS: Compared with the control session, the ankle reflex teaching intervention did not lead to significantly greater improvement in students' ability to master this difficult neurologic examination skill. This study demonstrates the feasibility of using a rigorous trial design to investigate methods of teaching students the neurologic examination. Further research is needed to define how best to teach these important skills.
RCT Entities:
BACKGROUND: Methods of teaching neurologic examination skills are understudied compared with general physical examination skills. Eliciting an ankle reflex is an important element of a screening neurologic examination and directly drives further patient evaluation, but many students and physicians perceive this skill to be difficult; as a result, ankle reflex testing is frequently incorrectly performed or omitted entirely. METHODS: Twenty-two medical student volunteers of various levels of training took part in a blinded, randomized study of a brief intervention used to teach how best to elicit ankle reflexes. Standardized patients were used with quantification of ankle reflexes using electrodiagnostic techniques, providing an objective gold standard. RESULTS: Both the control and intervention groups improved over the course of the trial with mean change scores for correctness (maximum = 6) significantly increasing from 2.68 +/- 1.5 to 4.23 +/- 1.2 (P = 0.003) before and after the training sessions. However, there was no difference in change scores between students receiving the intervention and those in the control group in the entire cohort (P = 1.0) or by year. In a multivariate model, no significant difference in change score was associated with the intervention teaching session. CONCLUSIONS: Compared with the control session, the ankle reflex teaching intervention did not lead to significantly greater improvement in students' ability to master this difficult neurologic examination skill. This study demonstrates the feasibility of using a rigorous trial design to investigate methods of teaching students the neurologic examination. Further research is needed to define how best to teach these important skills.
Authors: Frank Herbstreit; Stefanie Merse; Rainer Schnell; Marcel Noack; Daniel Dirkmann; Anna Besuch; Jürgen Peters Journal: Medicine (Baltimore) Date: 2017-02 Impact factor: 1.889