Division of Neurology, Department of Medicine, University of Ottawa, Ottawa, Canada.
Department of Otolaryngology-Head & Neck Surgery, University of Ottawa, Ottawa, Canada.
J Otolaryngol Head Neck Surg. 2024 Jan-Dec;53:19160216241288817. doi: 10.1177/19160216241288817.
The bedside head impulse test (bHIT) is a clinical method of assessing the vestibulo-ocular reflex. It is a critical component of the bedside assessment of dizzy patients and helps differentiate acute stroke from vestibular neuritis. A previous study on senior Otolaryngology residents showed poor competence in performing and interpreting the bHIT and called for specific evaluations in the Competency By Design (CBD) curriculum to remedy this. This study aimed to assess whether those competencies have improved after full implementation of CBD in residency programs.
Thirty post-graduate year 4 Otolaryngology residents in Canada were evaluated on the use of the bHIT using a written multiple-choice question (MCQ) examination, interpretation of bHIT videos, and performance of a bHIT. Ratings of bHIT performance were completed by 2 expert examiners (DT, DL) using the Ottawa Clinic Assessment Tool.
Only 6.7% (rater DT) and 20% (rater DL) of residents were found able to perform the bHIT independently. Inter-rater reliability was moderate (0.55, intraclass correlation). Mean scores were 70% (13.4% standard deviation) for video interpretation and 59% (20.6% standard deviation) for multiple-choice questions. Video interpretation scores did not correlate with bHIT ratings (Pearson = 0.11), but MCQs and bHIT ratings did correlate moderately (Pearson r = 0.52).Comparing to the prior study, residents performed worse on the bHIT (3.14 average score vs 3.64, < .01) and fewer residents performed the bHIT independently (6.7% vs 22%-rater DT, 20% vs 39%-rater DL). Residents also performed worse on MCQs (58.7% vs 70.9%, P = 0.038), though similarly on video interpretation (70% vs 65%, = .198).
Fourth year OTL-HNS residents in Canada are not competent in performing the bHIT. These findings have implications for refining competency-based curricula in the evaluation of critical physical exam skills.
床边头部脉冲测试（bHIT）是评估前庭眼反射的一种临床方法。它是评估头晕患者的床边评估的关键组成部分，并有助于将急性中风与前庭神经炎区分开来。先前对耳鼻喉科高级住院医师的研究表明，他们在进行和解释 bHIT 方面能力较差，并呼吁在能力设计（CBD）课程中进行具体评估以纠正这一问题。本研究旨在评估在住院医师计划中全面实施 CBD 后，这些能力是否有所提高。
加拿大的 30 名耳鼻喉科住院医师 4 年级的学员接受了书面多项选择题（MCQ）考试，bHIT 视频的解释以及 bHIT 的表现，以评估他们对 bHIT 的使用情况。bHIT 表现的评分由 2 名专家（DT、DL）使用渥太华诊所评估工具完成。
只有 6.7%（评分者 DT）和 20%（评分者 DL）的住院医师被发现能够独立进行 bHIT。评分者间的可靠性为中度（0.55，组内相关系数）。视频解释的平均得分为 70%（13.4%标准差），多项选择题的平均得分为 59%（20.6%标准差）。视频解释分数与 bHIT 评分没有相关性（Pearson = 0.11），但 MCQ 和 bHIT 评分之间存在中度相关性（Pearson r = 0.52）。与先前的研究相比，住院医师在 bHIT 上的表现更差（平均得分为 3.14 分，3.64 分，< 0.01），独立进行 bHIT 的住院医师更少（评分者 DT 为 6.7%，评分者 DL 为 20%）。住院医师在 MCQ 上的表现也更差（58.7%对 70.9%，P = 0.038），但在视频解释上的表现相似（70%对 65%， = 0.198）。
加拿大耳鼻喉科住院医师 4 年级的学员在进行 bHIT 方面能力不足。这些发现对完善基于能力的课程在评估关键体检技能方面具有重要意义。
