Kaleida Phillip H, Ploof Dianna L, Kurs-Lasky Marcia, Shaikh Nader, Colborn D Kathleen, Haralam Mary Ann, Ray Sean, Kearney Diana, Paradise Jack L, Hoberman Alejandro
Children's Hospital of Pittsburgh of UPMC, One Children's Hospital Dr, 4401 Penn Ave, General Academic Pediatrics, CHOB 3rd Floor, Pittsburgh, PA 15224, USA.
Pediatrics. 2009 Oct;124(4):e714-20. doi: 10.1542/peds.2008-2838. Epub 2009 Sep 28.
We developed a program for training in the diagnosis of otitis media that included images illustrating various otoscopic findings, mnemonic guides to recollection, and discrimination sessions that included feedback and assessments of diagnostic skills.
We prepared a computerized, interactive curriculum, Enhancing Proficiency in Otitis Media (ePROM), that was centered around assemblages of clinically diverse, still and video images of tympanic membranes (TMs). To assess curriculum effectiveness, we constructed a test, the Diagnostic Ear Assessment Resource, that consisted of 50 video TM images. We administered the test to 84 residents in pediatrics or family practice who had not been exposed to ePROM and, varying the order in which the images were presented, to another group of 102 residents in the same programs both before and after exposure to ePROM.
o Mean proportions of correct diagnoses in the Diagnostic Ear Assessment Resource were larger among residents who had been exposed to ePROM than among residents at comparable levels of training who had not been exposed (67% vs 62%; P = .007). Among residents exposed to ePROM, mean proportions of correct diagnoses were larger after exposure than before (67% vs 55%; P < .001).
A structured, computerized curriculum to supplement standard clinical training can enhance residents' abilities to interpret still and video images of TMs and may improve their skills in diagnosing otitis media.
我们开发了一个中耳炎诊断培训项目，其中包括展示各种耳镜检查结果的图像、用于记忆的助记指南以及包含诊断技能反馈和评估的辨别环节。
我们编写了一个名为“提高中耳炎诊断能力”（ePROM）的计算机化交互式课程，该课程以临床上不同的鼓膜静态和视频图像组合为核心。为评估课程效果，我们构建了一个名为“耳部诊断评估资源”的测试，其中包含50张鼓膜视频图像。我们将该测试应用于84名未接触过ePROM的儿科或家庭医学住院医师，并在不同的图像呈现顺序下，对另一组102名来自相同项目的住院医师在接触ePROM前后均进行了测试。
在“耳部诊断评估资源”中，接触过ePROM的住院医师的正确诊断平均比例高于未接触过且处于类似培训水平的住院医师（67%对62%；P = 0.007）。在接触ePROM的住院医师中，接触后正确诊断的平均比例高于接触前（67%对55%；P < 0.001）。
一个结构化的计算机化课程来补充标准临床培训，可以提高住院医师解读鼓膜静态和视频图像的能力，并可能改善他们诊断中耳炎的技能。
