Using unannounced standardized patients to assess residents' competency in asthma severity classification

The aim of this study was to test the hypothesis that an educational intervention would increase the competency of pediatric residents in classifying asthma severity as assessed using unannounced standardized patients (SPs).

Six SPs were trained to represent mild-intermittent, mild-persistent, moderate-persistent, and severe-persistent asthma. Data from a control group were obtained in 2002-2003. In 2003-2004, after an intervention, data were collected from an intervention group. The intervention consisted of a didactic session and posting the criteria for asthma severity classification. During precepting, faculty obtained a commitment from residents (N = 12) regarding the severity classification. Faculty and residents were blinded to the presence of SPs. The assigned severity of each SP was used as the criterion standard. Residents' severity classification was compared with the criterion standard. To test whether competency improved postintervention, we compared residents' performance by using intervention group versus control group and within-subject control comparisons. Bivariate analyses tested differences in proportions of categorical variables.

Fifty resident-SP encounters were analyzed. The intervention group performed significantly better than controls at each level of training in identifying persistent asthma: postgraduate year 3 (PGY3, 100% vs 71%), PGY2 (71% vs 50%), and PGY1 (50% vs 43%). They also performed significantly better in determining subclassifications of persistent asthma: PGY3 (87% vs 40%), PGY2 (67% vs 33%), and PGY1 (50% vs 33%). All had P < .05. Similarly, for within-subject control comparison, residents performed significantly better postintervention at identification and subclassification of persistent asthma than did the same residents at baseline.

An educational intervention resulted in significant improvements in the competency of residents in asthma severity classification.