Department of Medicine, Division of Neurology, University of Ottawa, Ottawa, Canada.
Department of Otolaryngology - Head & Neck Surgery, University of Ottawa, Ottawa, Canada.
J Otolaryngol Head Neck Surg. 2019 Jan 18;48(1):7. doi: 10.1186/s40463-019-0326-y.
The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex (VOR). It is a critical component of the bedside assessment of dizzy patients, and can help differentiate acute stroke from vestibular neuritis. However, there is evidence showing the bHIT is often not performed in appropriate clinical settings or is performed poorly. To date, there have been no studies evaluating the bHIT competence of graduating physicians.
23 final year Otolaryngology -Head &Neck Surgery (OTL-HNS) residents in Canada were evaluated on the use of bHIT using a written multiple-choice examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of subject bHIT performance were completed by two expert examiners (DT, DL) using the previously published Ottawa Clinic Assessment Tool (OCAT).
Using a cut-off of an OCAT score of 4 or greater, only 22% (rater DT) and 39% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was fair (0.51, interclass correlation). The mean scores were 65% (14.1% standard deviation) on the video interpretation and 71% (20.2% standard deviation) on the multiple-choice questions. The scores on multiple choice examination did not correlate with bHIT ratings (Pearson r = 0.07) but there was fair correlation between video interpretation and bHIT ratings (Pearson r = 0.45).
Final year OTL-HNS residents in Canada are not adequately trained in performing the bHIT, though low interrater reliability may limit the evaluation of this bedside skill. Multiple choice examinations do not reflect bHIT skill. These findings have implications for development of competency-based curricula and evaluations in Canada in critical physical exam skills.
床边头部脉冲测试（bHIT）是评估前庭眼反射（VOR）的一种临床方法。它是评估头晕患者的床边评估的关键组成部分，有助于将急性中风与前庭神经炎区分开来。然而，有证据表明，bHIT 通常未在适当的临床环境中进行，或者执行得很差。迄今为止，还没有研究评估毕业医生的 bHIT 能力。
加拿大的 23 名耳鼻喉科-头颈外科（OTL-HNS）最后一年住院医师接受了 bHIT 使用书面多项选择考试、bHIT 视频解释和 bHIT 表现的评估。两名专家考官（DT、DL）使用先前发表的渥太华诊所评估工具（OCAT）对受试者 bHIT 表现进行评分。
使用 OCAT 评分 4 或更高的截止值，只有 22%（评分者 DT）和 39%（评分者 DL）的住院医师被发现能够独立进行 bHIT。评分者之间的可靠性为中等（0.51，组内相关系数）。视频解释的平均得分为 65%（14.1%标准差），多项选择问题的平均得分为 71%（20.2%标准差）。多项选择考试成绩与 bHIT 评分无关（Pearson r=0.07），但视频解释与 bHIT 评分之间存在中等相关性（Pearson r=0.45）。
加拿大的耳鼻喉科-头颈外科最后一年住院医师在执行 bHIT 方面没有得到充分培训，尽管评分者之间的可靠性较低可能会限制对这种床边技能的评估。多项选择考试并不能反映 bHIT 技能。这些发现对加拿大关键体检技能的基于能力的课程和评估的发展具有影响。
