Training to Measure Ankle–Brachial Index at the Undergraduate Level

Abstract

We examined the effectiveness of teaching ankle-brachial index (ABI) measurement to medical students. ABI was estimated in 28 lower limbs by an experienced vascular surgeon. After a 2-week training course, 5 fourth-year students repeated the estimations and their results were compared with that of the trainer's. There was no difference in ABI values between trainees and trainer for subjects with mild-to-moderate peripheral arterial disease (PAD; 0.77 ± 0.22 vs 0.77 ± 0.19, respectively, P = .95). In the 4 normal limbs, ABI was 1.37 ± 0.12 and 1.16 ± 0.11, as measured by the trainer and the trainees, respectively (P < .00001). In subjects with severe PAD, trainees tended to overestimate ABI (P = .0002) in the beginning of the educational process, but this was no longer the case at a later stage of the training with no difference in ABI values between the 2 examiner groups (P = .09). In conclusion, training of medical students in ABI measurement can be helpful toward accurate estimation of PAD and merits further practice.

Knowledge about ankle-brachial index procedure among residents: being experienced is beneficial but is not enough

“…They also had signifi cantly higher ABI measurement and total scores (P = 0.0485 and P = 0.0332, respectively). These results are in accordance with previous literature that showed that practical training improved the compliance with guidelines [14,15]. Indeed, Georgakarakos et al (2013) showed that the completion of 20 measurements in patients was required to achieve enough competency level to avoid misdiagnosing of PAD [15].…”

“…These results are in accordance with previous literature that showed that practical training improved the compliance with guidelines [14,15]. Indeed, Georgakarakos et al (2013) showed that the completion of 20 measurements in patients was required to achieve enough competency level to avoid misdiagnosing of PAD [15]. However, even among experienced residents, none of them knew how to perform the entire ABI procedure without any mistake with regard to current guidelines.…”

“…An experienced resident was considered as a resident who declared having performed more than 20 ABI measurements in clinical practice. This cut-off of 20 measurements was based on a previous study by Georgakarakos et al [15]. This study was conducted according to the French Health laws.…”

“…Second, we assessed the residents' knowledge about the ABI measurement task through a questionnaire and not through a direct supervision, which was used by Wyatt et al [14]. As shown by the authors, the advantage of direct supervision is that respondents currently reported diffi culties regarding skills or technical aspects of the procedure such as locating pulses in the ankle, or maintaining the position of the Doppler probe while infl ating the blood pressure cuff [14,15,19]. However, our aim was to assess a high number of residents from diff erent French medical schools and not to focus on one, as reported by Wyatt et al [14].…”

Statement for Doppler waveforms analysis

“…A theoretical approach, as adopted by most French Medical Faculties to record the resting ABI, would probably be inappropriate [38]. Regarding ABI, a certain number of measurements must be recorded to build up competence [6,39,40]. Studies conducted by Scissons highlight a better system for classifying Doppler waveform morphologies with the person gaining experience with every waveform analysis [8,10].…”