Paul Caroline R, Higgins Joyce Alanna D, Beck Dallaghan Gary L, Keeley Meg G, Lehmann Corinne, Schmidt Suzanne M, Simonsen Kari A, Christy Cynthia
Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, 2870 University Avenue, Suite 200, Madison, WI, 53705, USA.
Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
BMC Med Educ. 2020 Nov 16;20(1):429. doi: 10.1186/s12909-020-02307-x.
Acute otitis media (AOM) is the most frequent indication for antibiotic treatment of children in the United States. Its diagnosis relies on visualization of the tympanic membrane, a clinical skill acquired through a deliberate approach. Instruction in pediatric otoscopy begins in medical school. Medical students receive their primary experience with pediatric otoscopy during the required pediatric clerkship, traditionally relying on an immersion, apprentice-type learning model. A better understanding of their preceptors' clinical and teaching practices could lead to improved skill acquisition. This study investigates how pediatric preceptors (PP) and members of the Council on Medical Student Education in Pediatrics (COMSEP) perceive teaching otoscopy.
A 30-item online survey was administered to a purposeful sample of PP at six institutions in 2017. A comparable 23-item survey was administered to members through the 2018 COMSEP Annual Survey. Only COMSEP members who identified themselves as teaching otoscopy to medical students were asked to complete the otoscopy-related questions on the survey.
Survey respondents included 58% of PP (180/310) and 44% (152/348) of COMSEP members. Forty-one percent (62/152) of COMSEP member respondents identified themselves as teaching otoscopy and completed the otoscopy-related questions. The majority agreed that standardized curricula are needed (PP 78%, COMSEP members 97%) and that all graduating medical students should be able to perform pediatric otoscopy (PP 95%, COMSEP members 79%). Most respondents reported usefulness of the American Academy of Pediatrics (AAP) AOM guidelines (PP 95%, COMSEP members 100%). More COMSEP members than PP adhered to the AAP's diagnostic criteria (pediatric preceptors 42%, COMSEP members 93%). The most common barriers to teaching otoscopy were a lack of assistive technology (PP 77%, COMSEP members 56%), presence of cerumen (PP 58%, COMSEP members 60%), time to teach in direct patient care (PP 46%, COMSEP members 48%), and parent anxiety (PP 62%, COMSEP members 54%).
Our study identified systemic and individual practice patterns and barriers to teaching pediatric otoscopy. These results can inform education leaders in supporting and enabling preceptors in their clinical teaching. This approach can be adapted to ensure graduating medical students obtain intended core clinical skills.
急性中耳炎（AOM）是美国儿童抗生素治疗最常见的适应症。其诊断依赖于鼓膜可视化，这是一项通过刻意练习获得的临床技能。儿科耳镜检查教学始于医学院校。医学生在必修的儿科实习期间获得了儿科耳镜检查的主要经验，传统上依赖沉浸式的学徒式学习模式。更好地了解他们的带教老师的临床和教学实践可能会提高技能的掌握。本研究调查了儿科带教老师（PP）和儿科学医学生教育委员会（COMSEP）成员对耳镜检查教学的看法。
2017年，对6家机构的PP进行了有目的抽样的30项在线调查。通过2018年COMSEP年度调查对成员进行了类似的23项调查。仅要求那些自认为在向医学生教授耳镜检查的COMSEP成员完成调查中与耳镜检查相关的问题。
调查对象包括58%的PP（180/310）和44%的COMSEP成员（152/348）。41%（62/152）的COMSEP成员受访者自认为在教授耳镜检查并完成了与耳镜检查相关的问题。大多数人认为需要标准化课程（PP为78%，COMSEP成员为97%），并且所有即将毕业的医学生都应该能够进行儿科耳镜检查（PP为95%，COMSEP成员为79%）。大多数受访者报告了美国儿科学会（AAP）AOM指南的有用性（PP为95%，COMSEP成员为100%）。遵守AAP诊断标准的COMSEP成员比PP更多（儿科带教老师为42%，COMSEP成员为93%）。耳镜检查教学最常见的障碍是缺乏辅助技术（PP为77%，COMSEP成员为56%）、存在耵聍（PP为58%，COMSEP成员为60%）、直接患者护理中的教学时间（PP为46%，COMSEP成员为48%）以及家长焦虑（PP为62%，COMSEP成员为54%）。
我们的研究确定了儿科耳镜检查教学的系统和个人实践模式及障碍。这些结果可以为教育领导者提供信息，以支持和帮助带教老师进行临床教学。这种方法可以进行调整，以确保即将毕业的医学生获得预期的核心临床技能。
