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Two Educational Interventions to Improve Pediatricians' Knowledge and Skills in Performing Ankle and Knee Physical Examinations
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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