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Assessing Resident Diagnostic Skills Using a Modified Bronchiolitis Score.

Andrea Rivera-Sepulveda1,2, Muguette Isona3

  • 1Pediatrics, Emergency Medicine, Nemours Children's Hospital, Orlando, FL, United States.

Pediatric Oncall
|March 8, 2021
PubMed
Summary

A standardized tool improved resident diagnostic skills in bronchiolitis assessment, showing excellent reliability for vital signs and overall scores between pediatric attendings and residents. This aids in identifying resident learning needs.

Keywords:
board-certifiedbronchiolitisdiagnostic skillsinter-raterpediatricpediatric emergency departmentpediatricianresidentscore

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Area of Science:

  • Pediatric emergency medicine
  • Medical education
  • Clinical assessment tools

Background:

  • Resident milestones rely on subjective attending evaluations, with limited data on standardized tools for resident diagnostic skills.
  • Standardized instruments can objectively complement resident skill assessment in academic settings.

Purpose of the Study:

  • To evaluate a modified bronchiolitis severity assessment tool.
  • To appraise inter-rater variability and reliability between pediatric attendings and residents.

Main Methods:

  • Cross-sectional study of 20 children under 24 months with bronchiolitis.
  • Paired pediatric attending and resident evaluations included respiratory rate, retractions, SpO2, and auscultation.
  • Cohen's kappa (K) and intra-class correlation (ICC) assessed inter-rater agreement and reliability.

Main Results:

  • Excellent inter-rater reliability (ICC) was found for respiratory rate (0.97), SpO2 (1.0), auscultation (0.77), and total score (0.84).
  • Fair agreement (K) was observed for retractions (0.31), auscultation (0.33), and total score (0.3).
  • Identification of retractions showed the least agreement between raters.

Conclusions:

  • Standardized instruments, with trained staff, can identify resident clinical competency gaps.
  • These tools facilitate resident learning for identifying key clinical findings in pediatric patients.