Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study

Paul, Caroline R.; Keeley, Meg; Rebella, Gregory S.; Frohna, John G.

doi:10.1016/j.acap.2018.02.009

Cited by 16 publications

(36 citation statements)

References 10 publications

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“…9 Gaining an understanding of preceptors' clinical and teaching practices is a crucial rst step toward improving student learning and skill acquisition, which can ultimately impact patient outcomes. 1,6,8 Preceptors (PP) and education leaders (CM) in our study strongly agreed that all graduating medical students should learn basic pediatric otoscopy skills and that there is a need for the implementation of standardized curricula for effective teaching. Preceptors need practical strategies, support, and infrastructure in their clinics to implement these curricula.…”

Section: Discussionmentioning

confidence: 72%

“…Despite this emphasis in the most recent AAP 2013 Clinical Practice Guidelines on AOM, literature on the use of the AAP Guidelines, implementation of standardized curricula, and teaching in real-time clinical settings are lacking. 1,6,8 Little is known about the informal training that preceptors deliver to their learners on pediatric otoscopy, although it is clear that preceptor practices and attitudes can affect student performance of these skills. 9 Gaining an understanding of preceptors' clinical and teaching practices is a crucial rst step toward improving student learning and skill acquisition, which can ultimately impact patient outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…14 Peer-reviewed standards informed the content of both surveys. 1,6 The nal surveys were created through an iterative process. First, expert group consensus generated general themes of inquiry for a focus group.…”

Section: Methodsmentioning

confidence: 99%

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Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Paul

Joyce²,

Dallaghan

et al. 2020

Preprint

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Background Acute otitis media (AOM) is the most frequent indication for antibiotic treatment of children in the United States. Its diagnosis relies on visualization of the tympanic membrane, a clinical skill acquired through a deliberate approach. Instruction in pediatric otoscopy begins in medical school. Medical students receive their primary experience with pediatric otoscopy during the required pediatric clerkship, traditionally relying on an immersion, apprentice-type learning model. A better understanding of their preceptors’ clinical and teaching practices could lead to improved skill acquisition. This study investigates how pediatric preceptors (PP) and members of the Council on Medical Student Education in Pediatrics (COMSEP) perceive teaching otoscopy. Methods A 30-item online survey was administered to a purposeful sample of PP at six institutions in 2017. A comparable 23-item survey was administered to members through the 2018 COMSEP Annual Survey. Only COMSEP members who identified themselves as teaching otoscopy to medical students were asked to complete the otoscopy-related questions on the survey. Results Survey respondents included 58% of PP (180/310) and 44% (152/348) of COMSEP members. Forty-one percent (62/152) of COMSEP member respondents identified themselves as teaching otoscopy and completed the otoscopy-related questions. The majority agreed that standardized curricula are needed (PP 78%, COMSEP members 97%) and that all graduating medical students should be able to perform pediatric otoscopy (PP 95%, COMSEP members 79%). Most respondents reported usefulness of the American Academy of Pediatrics (AAP) AOM guidelines (PP 95%, COMSEP members 100%). More COMSEP members than PP adhered to the AAP’s diagnostic criteria (pediatric preceptors 42%, COMSEP members 93%). The most common barriers to teaching otoscopy were a lack of assistive technology (PP 77%, COMSEP members 56%), presence of cerumen (PP 58%, COMSEP members 60%), time to teach in direct patient care (PP 46%, COMSEP members 48%), and parent anxiety (PP 62%, COMSEP members 54%). Conclusions Our study identified systemic and individual practice patterns and barriers to teaching pediatric otoscopy. These results can inform education leaders in supporting and enabling preceptors in their clinical teaching. This approach can be adapted to ensure graduating medical students obtain intended core clinical skills.

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Section: Discussionmentioning

confidence: 72%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Paul

Joyce²,

Dallaghan

et al. 2020

Preprint

View full text Add to dashboard Cite

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“…1,3 The American Academy of Pediatrics (AAP) 2013 Clinical Practice Guidelines stresses that diagnosis of AOM relies on adequate visualization of the tympanic membrane, 1 a clinical skill acquired through a deliberate, stepwise approach. 4,6 The AAP recommends that instruction in the evaluation of the middle ear begin "in medical school and continue throughout postgraduate training." 1 Especially given that physicians other than pediatricians will diagnose children with AOM, delivering standardized otoscopy curricula to trainees in medical school is "an absolute necessity" for "the most widespread effect" on clinical practice.…”

Section: Introductionmentioning

confidence: 99%

“…7 Despite expert recommendations, peer-reviewed curricula in pediatric otoscopy have emerged only recently. 4,6,8,9 Such curricula have demonstrated gains in knowledge and skills that translate to the clinical setting. 3,4 However, their actual use in clinical teaching is unknown and relies on the individual faculty responsible for teaching pediatric otoscopy.…”

Section: Introductionmentioning

confidence: 99%

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Paul

Joyce²,

Dallaghan

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: Acute otitis media (AOM) is the most frequent indication for antibiotic treatment of children in the United States. Its diagnosis relies on visualization of the tympanic membrane, a clinical skill acquired through a deliberate approach. Instruction in pediatric otoscopy begins in medical school. Medical students receive their primary experience with pediatric otoscopy during the required pediatric clerkship, traditionally relying on an immersion, apprentice-type learning model. A better understanding of their preceptors’ clinical and teaching practices could lead to improved skill acquisition. This study investigates how pediatric preceptors (PP) and members of the Council on Medical Student Education in Pediatrics (COMSEP) perceive teaching otoscopy. Methods: A 30-item online survey was administered to a purposeful sample of PP at six institutions in 2017. A comparable 23-item survey was administered to members through the 2018 COMSEP Annual Survey. Only COMSEP members who identified themselves as teaching otoscopy to medical students were asked to complete the otoscopy-related questions on the survey. Results: Survey respondents included 58% of PP (180/310) and 44% (152/348) of COMSEP members. Forty-one percent (62/152) of COMSEP member respondents identified themselves as teaching otoscopy and completed the otoscopy-related questions. The majority agreed that standardized curricula are needed (PP 78%, COMSEP members 97%) and that all graduating medical students should be able to perform pediatric otoscopy (PP 95%, COMSEP members 79%). Most respondents reported usefulness of the American Academy of Pediatrics (AAP) AOM guidelines (PP 95%, COMSEP members 100%). More COMSEP members than PP adhered to the AAP’s diagnostic criteria (pediatric preceptors 42%, COMSEP members 93%). The most common barriers to teaching otoscopy were a lack of assistive technology (PP 77%, COMSEP members 56%), presence of cerumen (PP 58%, COMSEP members 60%), time to teach in direct patient care (PP 46%, COMSEP members 48%), and parent anxiety (PP 62%, COMSEP members 54%). Conclusions: Our study identified systemic and individual practice patterns and barriers to teaching pediatric otoscopy. These results can inform education leaders in supporting and enabling preceptors in their clinical teaching. This approach can be adapted to ensure graduating medical students obtain intended core clinical skills.

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Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children

Shaikh,

Conway,

Kovačević

et al. 2024

JAMA Pediatr

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ImportanceAcute otitis media (AOM) is a frequently diagnosed illness in children, yet the accuracy of diagnosis has been consistently low. Multiple neural networks have been developed to recognize the presence of AOM with limited clinical application.ObjectiveTo develop and internally validate an artificial intelligence decision-support tool to interpret videos of the tympanic membrane and enhance accuracy in the diagnosis of AOM.Design, Setting, and ParticipantsThis diagnostic study analyzed otoscopic videos of the tympanic membrane captured using a smartphone during outpatient clinic visits at 2 sites in Pennsylvania between 2018 and 2023. Eligible participants included children who presented for sick visits or wellness visits.ExposureOtoscopic examination.Main Outcomes and MeasuresUsing the otoscopic videos that were annotated by validated otoscopists, a deep residual-recurrent neural network was trained to predict both features of the tympanic membrane and the diagnosis of AOM vs no AOM. The accuracy of this network was compared with a second network trained using a decision tree approach. A noise quality filter was also trained to prompt users that the video segment acquired may not be adequate for diagnostic purposes.ResultsUsing 1151 videos from 635 children (majority younger than 3 years of age), the deep residual-recurrent neural network had almost identical diagnostic accuracy as the decision tree network. The finalized deep residual-recurrent neural network algorithm classified tympanic membrane videos into AOM vs no AOM categories with a sensitivity of 93.8% (95% CI, 92.6%-95.0%) and specificity of 93.5% (95% CI, 92.8%-94.3%) and the decision tree model had a sensitivity of 93.7% (95% CI, 92.4%-94.9%) and specificity of 93.3% (92.5%-94.1%). Of the tympanic membrane features outputted, bulging of the TM most closely aligned with the predicted diagnosis; bulging was present in 230 of 230 cases (100%) in which the diagnosis was predicted to be AOM in the test set.Conclusions and RelevanceThese findings suggest that given its high accuracy, the algorithm and medical-grade application that facilitates image acquisition and quality filtering could reasonably be used in primary care or acute care settings to aid with automated diagnosis of AOM and decisions regarding treatment.

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Teaching Pediatric Otoscopy Skills to Pediatric and Emergency Medicine Residents: A Cross-Institutional Study

Cited by 16 publications

References 10 publications

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Teaching Pediatric Otoscopy Skills to the Medical Student in the Clinical Setting: Preceptor Perspectives and Practice

Development and Validation of an Automated Classifier to Diagnose Acute Otitis Media in Children

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