Training to Perform Ankle-Brachial Index: Systematic Review and Perspectives to Improve Teaching and Learning

Chaudru, Ségolène; Müllenheim, Pierre-Yves de; Faucheur, Alexis Le; Kaladji, Adrien; Jaquinandi, Vincent; Mahé, Guillaume

doi:10.1016/j.ejvs.2015.09.005

Cited by 47 publications

(47 citation statements)

References 25 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Several studies have also shown that ABI is not accurately performed in general practice [9 -11]. A possible explanation may be a lack of knowledge about the ABI procedure caused by poor educational processes [12]. Only a few studies [13,14] have addressed the basic knowledge of the ABI procedure among residents and/or students, whereas these results may provide recommendations for optimal medical educational processes.…”

Section: Introductionmentioning

confidence: 81%

“…The opportunity to have practical training should be off ered, since the majority of residents (78 %) stated that they would like to receive more practical training. Finally, on the basis of these fi ndings, we recommended, as previously suggested by Ray et al (1994), that junior doctors should not perform ABI measurements alone until they have performed several ABI procedures under supervision with an appropriately experienced instructor [12,19].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

Chaudru

Müllenheim

Faucheur

et al. 2016

Vasa

View full text Add to dashboard Cite

Summary:Background: Ankle-brachial index (ABI) at rest is the main clinical tool to diagnose the presence of lower extremity peripheral artery disease (PAD). The method for ABI procedure (i.e., measurement, calculation and interpretation) is standardised and guidelines were published in 2012. This study sought to: i) assess knowledge about the three major steps of the ABI procedure (i.e., measurement, calculation and interpretation) among residents from different medical schools, ii) compare the ABI knowledge of experienced residents (i.e., who have already performed ABI procedure more than 20 times) with the knowledge of inexperienced residents, and iii) describe the most common errors by residents. Methods: Residents from six medical schools were invited to complete a questionnaire about the ABI procedure. Results: Sixty-eight residents completed the questionnaire. None of them knew how to perform the entire ABI procedure. Overall, 22 %, 13 % and 41 % of residents correctly answered questions about ABI measurement, ABI calculation and ABI interpretation, respectively. Score comparisons underlined the fact that experienced residents (n = 26) answered ABI measurement questions to a signifi cantly better level and had a signifi cantly higher total score than inexperienced residents (n = 42) (P = 0.0485 and P = 0.0332, respectively). Errors were similar for most of the residents. Conclusions: Our study confi rms that experienced residents have signifi cantly better ABI procedure knowledge than inexperienced residents. However, none of them are able to perform the entire ABI procedure without any mistake with regard to current guidelines. It is important that training be given to residents in medical schools in order to improve their ABI procedure knowledge.

show abstract

Section: Introductionmentioning

confidence: 81%

Section: Discussionmentioning

confidence: 99%

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

Chaudru

Müllenheim

Faucheur

et al. 2016

Vasa

View full text Add to dashboard Cite

show abstract

“…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].…”

Section: Teaching Methodsmentioning

confidence: 99%

“…This disease generates a signifi cant morbidity-mortality rate with an estimated cardiovascular mortality rate of 15 to 30 % within fi ve years [4]. The diagnosis of PAD is primarily based on the use of the resting ankle-brachial pressure index (ABI), an ABI < or = 0.90 defi ning PAD [5][6][7].…”

Section: Introductionmentioning

confidence: 99%

Statement for Doppler waveforms analysis

Mahé

Boulon

Desormais³

et al. 2017

Vasa

View full text Add to dashboard Cite

Summary: Peripheral artery disease of the lower limbs (PAD) is a common disease. Evaluation of PAD is primarily based on non-invasive examinations with analysis of the arterial Doppler signal being a key element. However, the description of arterial Doppler waveforms morphologies varies considerably across medical schools and from country to country. In order to overcome this issue, the French College of Teachers for Vascular Medicine (Collège des Enseignants de Médecine Vasculaire; CEMV) has summarised the published data on Doppler waveforms analysis and proposes a new "Saint-Bonnet" classifi cation system to describe Doppler waveforms morphologies. The simplifi ed Saint-Bonnet classifi cation comprises eight types and allows taking into account if the Doppler signal does not revert to baseline. This classifi cation, which is based on previous classifi cations, could improve the descriptions of both physiological and pathological waveforms, recorded in lower limb arteries. According to the reviewed literature, recommendations about the use of Doppler waveforms are proposed. This statement is a preamble to reach an international consensus on the subject, which would standardize the description of arterial waveforms and improve the management of PAD patients.

show abstract

“…4 In this regard, the report of Donnou and colleagues 5 in this issue of Vascular Medicine can be considered as the first attempt to scientifically assess an ABI teaching experience, through a randomized trial with a satisfying number of trainees (n=30). The trial was designed to assess the experiential component of the teaching after didactic learning for all students.…”

mentioning

confidence: 99%

Teaching and evaluating measurement of the ankle–brachial index

Aboyans

Lacroix

2018

Vasc Med

View full text Add to dashboard Cite

Peripheral artery disease (PAD) is one of the most frequent cardiovascular conditions and paradoxically one of the most neglected ones. Although the reasons for the underdiagnosis of PAD are multifactorial, it cannot be related to difficulties in screening and detecting this condition.Actually, measurement of the ankle-brachial index (ABI) is harmless and highly accessible at a limited cost, with satisfying sensitivity and specificity to detect PAD. 1 The technical aspects for correct use seem far more accessible to technicians, nurses, and physicians as compared to many other cardiovascular diagnostic tools. 1 For all these reasons, several international guidelines concur to advocate for the use of the ABI as the first diagnostic tool to identify PAD. 1-3 A document in 2012 provided standards for the measurement, calculation, and interpretation of the ABI in order to limit discrepancies observed in the past. 1 The document emphasized the importance of training to improve the reproducibility and reliability of results and recommended the measurement and interpretation of the ABI as part of the curriculum for medical and nursing students, based on didactic and experiential learning under the supervision of qualified trainers. However, studies providing insights on the best way to teach and learn measurement of the ABI were sparse, and no specific recommendations have been proposed.Indeed, a recent literature review highlighted the paucity of teaching experiences, mostly performed on a low number of trainees, and overall rated as low quality. 4 In this regard, the report of Donnou and colleagues 5 in this issue of Vascular Medicine can be considered as the first attempt to scientifically assess an ABI teaching experience, through a randomized trial with a satisfying number of trainees (n=30). The trial was designed to assess the experiential component of the teaching after didactic learning for all students. None of the students who benefitted from didactic-only teaching were considered to be proficient, but half (11/20) of those who also had experiential teaching over 3 hours were qualified as proficient.While the authors should be commended for their study, several aspects need further investigation to clarify and advocate the best way for teaching the ABI measurement.Ideally, more details about the material used for the didactic learning component should have been shared (e.g. through a video online supplement). Indeed, the reproducibility of the study if performed elsewhere is questionable.The experiential group of students was split into two subgroups: one training on healthy individuals (i.e. the students measuring each other's ABIs) and the other on actual patients in the vascular lab. The rational for this distinction is unclear, especially given that the results of both subgroups were ultimately provided together. By mixing healthy individuals and patients, the students would theoretically be confronted with a higher number of training sessions and a larger spectrum of ABIs. Another possibility would be t...

show abstract

Training to Perform Ankle-Brachial Index: Systematic Review and Perspectives to Improve Teaching and Learning

Cited by 47 publications

References 25 publications

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

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

Statement for Doppler waveforms analysis

Teaching and evaluating measurement of the ankle–brachial index

Contact Info

Product

Resources

About