Training effectiveness when teaching the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI) to medical students

Abstract

Study design: Interventional training sessions. Objectives: To examine the effectiveness of training medical students in the International Standards for Neurological Classification of Spinal Cord Injury (ISNCSCI). Setting: A Peking University teaching hospital. Methods: A total of 46 medical students were involved in the study. First, they had a 2-h self-study session with the ISNCSCI booklet, followed by a 10-item questionnaire. The booklet was allowed for use as a reference during this assessment. Two days later, the questionnaire was repeated without the use of reference. Students then had a session with case discussion, followed by a final questionnaire. Results: After the initial self-study session, the mean score (max. 10) on the questionnaire was 7.67 ± 1.49. Two days later, the mean score of the second test was 7.96 ± 1.15. All key points of the ISNCSCI were supplemented during the second session with case presentations. The mean score of the final test increased significantly to 9.61±0.88 (Po0.01) in comparison with the previous tests. The overall correct response rates by students in determining sensory level, motor level and American Spinal Injury Association Impairment Scale of the training case were 89.1%, 84.8% and 91.3%, respectively. Conclusion: The training effectiveness of ISNCSCI through self-study is reliable. The correct answers to key points could remain for at least 2 days without the need to use a reference. However, some specialized knowledge could not be transmitted without more detailed discussions and case presentations. Utilization of cases is a valuable method in training ISNCSCI and can improve the overall training effectiveness.

International standards for neurological classification of spinal cord injury: classification skills of clinicians versus computational algorithms

“…This kind of analysis was previously performed exclusively in the artificial setting of ISNCSCI instructional courses. 7,[10][11][12][13][14][15][16][17][18][19][20][21] In the framework of instructional courses, the effects of a formal ISNCSCI training are typically assessed by the same test before (pre-test) and after the training (post-test). In both tests, the attendees rate and classify a predefined set of ISNCSCI cases.…”

International standards for neurological classification of spinal cord injury: impact of the revised worksheet (revision 02/13) on classification performance

“…AIS classification performances above 90% still seem to be hard to achieve. Liu et al postulated 15 that NLI classification performance does not need be evaluated, because the NLI can be deduced from SLs and MLs. However, we found approximately 9% misclassified NLIs, revealing that the NLI is actually the third most error-prone ISNCSCI variable after ML and AIS.…”

Sensitivity and specificity of the ‘knee-up test’ for estimation of the American Spinal Injury Association Impairment Scale in patients with acute motor incomplete cervical spinal cord injury

“…Several studies reported the inter-rater and intra-rater reliability of ISNCSCI [15][16][17][18][19][20][21][22][23][24][25][26]. Generally, intra-rater and inter-rater agreements among trained or experienced raters were acceptable; [17,[21][22][23] however, even for trained examiners, the agreements of sensory and/or motor examination were less reliable in patients with an incomplete SCI than in those with a complete SCI [19,22].…”

“…In order to accurately assess AIS, it is mandatory to determine the sensory level, sensory scores, motor level and strength of the key muscles using the ISNCSCI classification [14]. The ISNCSCI method was tested for its inter-and intra-rater reliabilities [15][16][17][18][19][20][21][22][23][24][25][26]. This method is slightly complicated, and several studies illustrated that training and experience may be required for accurate agreement [15,20,21,25,26].…”

“…The ISNCSCI method was tested for its inter-and intra-rater reliabilities [15][16][17][18][19][20][21][22][23][24][25][26]. This method is slightly complicated, and several studies illustrated that training and experience may be required for accurate agreement [15,20,21,25,26]. Importantly, some studies reported that the reliability of sensory and motor components of ISNCSCI in patients with incomplete SCI was lower than that in patients with complete SCI [15,19,20,22,26].…”