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Albert C. Hergenroeder, MD; Joseph N. Chorley, MD; Larry Laufman, EdD; Amy Fetterhoff, BS

Arch Pediatr Adolesc Med. 2002;156:225-229.

Background  Methods are needed to improve pediatricians' skills for physical examination of the ankle and knee.

Objective  To compare the effect of 2 methods of teaching the physical examination of the ankle and knee on the knowledge and skills of pediatricians.

Design  Prospective intervention trial with preintervention and postintervention tests.

Setting  Pediatricians' offices.

Participants  Twenty-three practice groups of community pediatricians, including 75 pediatricians (74% of the eligible sample).

Interventions  Practice groups were assigned by clustered randomization to 1 of 2 teaching interventions: (1) a videotape showing correct performance of the ankle and knee physical examinations (videotape only; 15 groups) and (2) the same videotape plus a skills building session (18 groups). The randomization was stratified by practice size.

Main Outcome Measures  Knowledge of ankle and knee examinations and ankle and knee physical examination skills, assessed by means of a Clinical Skills Assessment Examination (CSAE), at 18 weeks.

Results  The pediatricians' baseline mean ankle CSAE score was 26% correct in both groups. These scores improved to 44% and 59% correct in the videotape and videotape plus skills instruction groups, respectively, at 18 weeks (P<.001 for both). The baseline mean knee CSAE score was 25% in both groups and improved to 30% (P = .02, videotape group) and 41% (P<.001, videotape plus skills instruction group) at 18 weeks. The change in CSAE scores was greater in the videotape plus skills instruction group. Written test scores improved significantly in both groups.

Conclusions  Pediatricians' skills were lacking at baseline. Both teaching interventions were associated with improved skills and knowledge.

From the Adolescent Medicine and Sports Medicine Section, Department of Pediatrics (Drs Hergenroeder and Chorley), and Department of Medicine (Dr Laufman), Baylor College of Medicine, and Wyle Laboratories, Life Sciences Systems and Services (Ms Fetterhoff), Houston, Tex.

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