Accuracy of in-patients ankle-brachial index measurement by medical students

Abstract

Summary:Background: Ankle brachial index (ABI) is a fi rst line non-invasive screening tool for peripheral arterial disease (PAD) in at risk populations. The need to extend ABI use in large population screening has urged its use by professionals other than vascular physicians. As advocated by the American Heart Association, ABI teaching is part of medical curriculum in several countries. We determine accuracy in ABI measurement by trained medical students compared with an experienced angiologist. Methods: Twelve 6th year medical students underwent 9 days of training at Lausanne University Hospital. Students and an experienced angiologist, blinded to students' results, screened consecutive hospitalised patients aged ≥ 65 or ≥ 50 with at least one cardiovascular risk factor during a 6-week period. Results: A total of 249 patients were screened of whom 59 (23.7 %) met the inclusion criteria. Median age was 80, 45.8 % were women, and 6.8 % were symptomatic. In total, 116 ABIs were available for analysis. Agreement between students and angiologist was moderate with a k-value of 0.498 (95 % confi dence interval: 0.389 -0.606). Overall accuracy and precision of PAD screening performed by students showed sensitivity of 73.2 % and specifi city of 88.0 %. Positive and negative predictive values were 76.9 % and 85.7 %, respectively; positive and negative likelihood ratios were 6.3 and 3, respectively. Conclusions: A nine day training program on ABI measurement is not suffi cient for inexperienced medical students to achieve an acceptable diagnostic accuracy in detecting PAD in at risk populations.

Noninvasive Peripheral Artery Disease Screening Tools: A Deficient Knowledge among French Vascular Residents from 4 Medical Schools

“…[ [13][14][15][16] One of the reasons may be the style of teaching as some authors have highlighted that the current academic training method may not have enough experiential ("hands-on") learning. This may have contributed to a poor level of competency with regard to the ABI procedure among residents.…”

“…This may have contributed to a poor level of competency with regard to the ABI procedure among residents. [13][14][15][16] ABI measurement teaching generally takes the form of lectures and in very few cases practical training. [18] However, it has been suggested that practical teaching would improve this competency.…”

“…[12] Yet, several studies have highlighted the lack of theoretical and practical training in measuring ABI at rest among students in medicine, residents, cardiology residents and young general physicians or surgeons . (13)(14)(15)(16) In France, a vascular medicine physician must complete a two-year residency in M A N U S C R I P T A C C E P T E D ACCEPTED MANUSCRIPT vascular medicine at a university hospital, in addition to completing a general medicine training period that lasts a minimum of eight years (general practitioner). There is a paucity of studies evaluating whether vascular medicine residents in France are aware of all the different types of pressure measurements and how to calculate and interpret them to diagnose individuals with PAD.…”

Impact of an Educational Intervention on Ankle–Brachial Index Performance Among Medical Students and Fidelity Assessment at Six Months

“…An ABI was considered to be accurate if the difference between the ABIs measured by the vascular specialist and the student was ≤ 0.15, as previously reported (7,8) . Furthermore, this cut-off was chosen since a decrease of the ABI > 0.15 over time is effective for detecting significant PAD progression, as stated in the AHA recommendations (4) .…”

Ankle-brachial index measurement: Skill cannot be taken for granted Comment on Chaudru et al, p. 37 - 41 and Monti et al, p. 43 - 48

“…The paper of Monti et al [3] deals with the practical knowledge of ABI measurement, acquired by twelve 6th year medical students during a nine-day training unit. The form of training corresponded to the proposals of the American Heart Association [2].…”