Advertisement

Assessment of Pediatric Residents' Otoscopic Interpretive Skills by Videotaped Examinations

  • Woodson S. Jones
    Correspondence
    Address correspondence to Woodson Scott Jones, Department of Pediatrics, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814-4799
    Affiliations
    From the San Antonio Military Pediatric Center (Dr Jones), Lackland AFB, Tex.

    Uniformed Services University (Drs Jones and Lopreiato), Bethesda, Md
    Search for articles by this author
  • Phillip H. Kaleida
    Affiliations
    From the San Antonio Military Pediatric Center (Dr Jones), Lackland AFB, Tex.

    University of Pittsburgh School of Medicine and Children's Hospital of Pittsburgh (Dr Kaleida), Pittsburgh, Pa
    Search for articles by this author
  • Joseph O. Lopreiato
    Affiliations
    From the San Antonio Military Pediatric Center (Dr Jones), Lackland AFB, Tex.

    Uniformed Services University (Drs Jones and Lopreiato), Bethesda, Md

    National Capital Consortium Pediatric Residency Program (Dr Lopreiato), Bethesda, Md
    Search for articles by this author
      Background.—Accurate diagnosis of otitis media is essential to facilitate appropriate management. Few residency programs assess formally their residents' competency in diagnosing middle ear disease.
      Objective.—To evaluate the performance of pediatric residents' otoscopic interpretive skills by level of training, with a videotaped otoendoscopic examination (VOE).
      Methods.—A VOE was used to assess and compare the performance of a cross-sectional sample of 141 residents with one another by level of training as well as with novice and expert groups. Total score, sensitivity, specificity, and kappa coefficients were calculated for each subject by comparing the subject's answers on the 50-ear test with the VOE's expert panel–derived answers, and averages were determined for each training level.
      Results.—Each pediatric resident training group had moderate agreement (mean κ coefficient range: .45–.56) with the VOE answers, compared with the novice group (mean κ: .31, fair) and expert group (mean κ: .80, substantial). Twenty-eight residents (20%) had fair or less agreement (κ < .41) with the VOE answers. The mean total scores of all pediatric resident training levels were significantly (P < .05) lower than the expert group and significantly (P < .05) higher than the novice group (with exception of the early postgraduate year-1 group). Subjects with more training had higher kappa levels (r = .33, <.001, Spearman) when results were compared among novice, residents, and experts.
      Conclusions.—We found the VOE to be a feasible and reliable instrument to accurately distinguish novice, resident, and expert level skills in the determination of middle ear effusion status.

      KEY WORDS

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Academic Pediatrics
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • Paradise JL
        Managing otitis media: a time for change.
        Pediatrics. 1995; 96: 712-715
        • Dowell SF
        • Marcy SM
        • Phillips WR
        • et al.
        Otitis media—principles for judicious use of antimicrobial agents.
        Pediatrics. 1998; 101: 165-171
        • Klein JO
        Clinical implications of antibiotic resistance for management of acute otitis media.
        Pediatr Infect Dis J. 1998; 17: 1084-1089
        • Bain DJ
        Training for general practice: clinical behaviour in trainers and trainees.
        BMJ. 1984; 288: 762-764
        • Steinbach WJ
        • Sectish TC
        • Benjamin DK
        • et al.
        Pediatric residents' clinical diagnostic accuracy of otitis media.
        Pediatrics. 2002; 109: 993-998
        • Pichichero ME
        • Poole MD
        Assessing diagnostic accuracy and tympanocentesis skills in the management of otitis media.
        Arch Pediatr Adolesc Med. 2001; 155: 1137-1142
        • Pichichero ME
        Diagnostic accuracy, tympanocentesis training performance, and antibiotic selection by pediatric residents in management of otitis media.
        Pediatrics. 2002; 110: 1064-1070
        • Kaleida PH
        • Hoberman A
        • Smith CG
        Videotaped otoendoscopic examinations in clinical education and research.
        Pediatr Res. 1992; 31: 123A
        • Kaleida PH
        • Hoberman A
        • Smith CG
        Videotaped otoendoscopic examinations in clinical education and research: 1995 update.
        Arch Pediatr Adolesc Med. 1995; 149: 117
        • Stool SE
        • Flaherty MR
        Validation of otitis media with effusion.
        Ann Otol Rhinol Laryngol. 1983; 92: 5-6
        • Hengerer AS
        Otoendoscopic examinations, training videotape 1 and test videotape 1 (review).
        Int J Pediatr Otolaryngol. 1996; 35: 74
        • Walner DL
        • Cotton RT
        Videotaped otoendoscopic examinations series: test videotape 2 and training videotape 2 (videotape review).
        J Pediatr. 1996; 129: 49
        • Walner DL
        • Cotton RT
        Videotaped otoendoscopic examinations series: test videotape 3 and training videotape 3 (videotape review).
        J Pediatr. 1996; 132: 435
        • Landis J
        • Koch GG
        The measurement of observer agreement for categorical data.
        Biometrics. 1977; 33: 159-174
        • Steinbach WJ
        • Sectish TC
        Pediatric resident training in the diagnosis and treatment of acute otitis media.
        Pediatrics. 2002; 109: 404-408
        • Accreditation Council for Graduate Medical Education.
        Outcome Project.
        (Accessed May 2003)