From the Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut.
South Med J. 2024 Sep;117(9):556-561. doi: 10.14423/SMJ.0000000000001732.
Hypertension (HTN) affects nearly half of US adults. Our multi-institutional survey revealed that Internal Medicine residents lack proficiency in advanced HTN topics. We developed a curriculum to address knowledge gaps in these topics and aimed to assess the effects of the curriculum on residents' confidence, desire for future training, and knowledge in advanced HTN topics.
HTN experts taught four advanced topics in HTN: conducting a workup for secondary HTN, managing HTN in chronic kidney disease, managing HTN in patients who are or may become pregnant, and managing hypertensive urgency (severe asymptomatic HTN) in the outpatient setting. The setting of the curriculum was an ambulatory educational half-day, during which residents rotated through small-group sessions dedicated to each HTN topic. We developed pre-, immediate post-, and 8 weeks postcurriculum surveys assessing residents' confidence and desire for future training in the four topics (4-point Likert scales), and multiple-choice quizzes to assess changes in knowledge. We used repeated-measures analysis of variance to compare means between time points for surveys and quizzes.
A total of 112 Internal Medicine residents participated in the curriculum. The mean confidence scores for all four topics increased from 1.79 to 2.61 precurriculum to 2.90 to 3.45 immediately postcurriculum (all < 0.001) and remained higher (2.53-3.18) than precurriculum at 8 weeks postcurriculum (all < 0.02). The mean desire for future training scores decreased from 2.74 to 2.96 precurriculum to 2.06 to 2.36 immediately postcurriculum (all < 0.001 except for managing HTN in patients who are or may become pregnant, which was = 0.17) and remained lower (2.08-2.36) than precurriculum at 8 weeks postcurriculum (all ≤ 0.003). The mean knowledge score increased from 48% precurriculum to 62% immediate postcurriculum ( < 0.001) and remained higher (55%) than precurriculum at 8 weeks postcurriculum ( = 0.015).
A curriculum on advanced HTN topics produced durable gains in confidence and knowledge and partially satisfied the desire for future learning among Internal Medicine residents.
高血压（HTN）影响近一半的美国成年人。我们的多机构调查显示，内科住院医师在高级 HTN 主题方面缺乏熟练程度。我们制定了一门课程来解决这些主题的知识差距，并旨在评估该课程对住院医师信心、未来培训愿望和高级 HTN 主题知识的影响。
高血压专家教授四个高级 HTN 主题：继发性 HTN 的检查、慢性肾脏病中的 HTN 管理、可能或已经怀孕的患者中的 HTN 管理以及门诊环境中高血压急症（无症状严重 HTN）的管理。课程的设置是一个半天的门诊教育，在此期间，住院医师轮流参加每个 HTN 主题的小组会议。我们制定了课前、即时课后和课程结束后 8 周的调查，评估住院医师在四个主题中的信心和未来培训的愿望（4 分李克特量表），并进行多项选择题测验以评估知识的变化。我们使用重复测量方差分析比较时间点之间的调查和测验的平均值。
共有 112 名内科住院医师参加了该课程。所有四个主题的平均信心得分从课前的 1.79 分提高到课后的 2.61 分，再提高到课后的 2.90 分至 3.45 分（均<0.001），并在课后 8 周时仍高于课前（均<0.02）。未来培训的平均愿望得分从课前的 2.74 分降至课后的 2.96 分，再降至课后的 2.06 分至 2.36 分（除了管理可能或已经怀孕的患者的 HTN 外，均<0.001，而管理可能或已经怀孕的患者的 HTN 为 0.17），并在课后 8 周时仍低于课前（均≤0.003）。平均知识得分从课前的 48%提高到课后的 62%（<0.001），并在课后 8 周时仍高于课前（55%）（=0.015）。
一门关于高级 HTN 主题的课程在住院医师的信心和知识方面产生了持久的收益，并在一定程度上满足了他们对未来学习的渴望。
