How to become proficient in performance of the resting ankle–brachial index: Results of the first randomized controlled trial

Abstract

The resting ankle-brachial index (ABI) is a first-line test to diagnose peripheral artery disease (PAD). No randomized controlled trial (RCT) has yet been conducted to determine the best teaching method to become proficient in the ABI procedure. We conducted a monocentric RCT to determine whether didactic learning alone or didactic learning combined with experiential learning improved proficiency in the ABI procedure. Medical students ( n = 30) received didactic learning, including (i) a presentation of the ABI guidelines and (ii) a video demonstration. Each student was then randomized into two groups ('no experiential learning group' and 'experiential learning group'). An initial evaluation was performed after the didactic learning and a final evaluation at the end of the intervention. A student was considered to be proficient when he or she performed a correct ABI procedure on a healthy individual and a patient. The correct procedure corresponds to (i) following guidelines and (ii) a difference in ABI measurement between a vascular specialist and a student of ≤ 0.15. No student was proficient at the initial evaluation. At the final evaluation, in the didactic learning group, the number of proficient students was not improved compared with the initial evaluation (0/10 vs 1/10). In the experiential learning group, the number of proficient students was significantly improved (0/20 vs 11/20; p < 0.05). At the final evaluation, there was a significant difference between the number of proficient students depending on their learning group. In conclusion, didactic learning alone is insufficient to gain proficiency in the ABI procedure. Combining didactic learning with experiential learning significantly improved the students' proficiency.

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

“…Given the importance of ABI in screening for PAD but also for CVD especially in asymptomatic patients, it is important for vascular physician to know ABI measurement and its interpretation, but above all it requires technical learning to obtain expertise from the beginning of medical studies and to optimize patient care. Previous study of our group has shown in a first randomized trial that didactic learning alone is insufficient to gain proficiency in the ABI procedure and combining didactic learning with experiential learning significantly improved the students' proficiency (5) . Moreover, Wyatt et al have defined a scoring sheet (Wyatt's score) to assess the proficiency in performance of the ABI (6) (Figure 1…”

Discordance of peripheral artery disease diagnosis using exercise transcutaneous oxygen pressure measurement and post-exercise ankle-brachial index

“…Thirdly, it was not possible to assess the reliability of the tests in this study. We do not have our own reliability for the exercise tests but the intra-observer coefficient of variation (CV) for the ABI at rest in our vascular laboratory is 9.4% (typical error of the estimate is 0.06) 36 . Furthermore, the reliability of the exercise tests has been previously reported by several studies: i) Van Langen et al showed that the inter-observer variability of the post-exercise ABI was 21% 37 ; ii) intra-test and test-retest reliability of exercise TcPO2 using a similar protocol that we used has been reported by Abraham and colleagues as excellent 17,18 .…”

Recommandations du Collège des enseignants de médecine vasculaire (CEMV) : analyse des flux artériels Doppler (classification de Saint-Bonnet simplifiée)

“…Cependant, dans certaines populations comme chez les diabétiques, les insuffisants rénaux, et les personnes âgées notamment, l'IPS de repos peut être faussement normal [5]. Dans ces cas et compte tenu des difficultés d'apprentissage, l'évaluation des flux Doppler peut apparaître comme intéressante [7][8][9][10]. Ainsi, l'artériopathie des membres inférieurs peut être définie au repos par [3,6,11]:…”