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Physicians' metered dose inhaler technique after a single teaching session
D J Resnick1, R L Gold, M Lee-Wong
1Department of Pediatrics, Division of Allergy, Columbia Presbyterian Medical Center, New York 10032, USA.
Background:
It is known that many housestaff physicians are unable to demonstrate perfect metered dose inhaler (MDI) technique.
Objective:
This study assessed whether a single teaching session for house staff physicians would significantly improve their MDI technique.
Methods:
Thirty-eight pediatric house staff physicians were asked to demonstrate MDI technique with a placebo MDI. The physicians were evaluated on the following seven steps: (1) shaking the MDI and removing the cap, (2) exhaling prior to MDI use, (3) holding the MDI upright, (4) proper timing of actuation, (5) a slow inspiratory effort, (6) one MDI actuation per breath, and (7) holding the breath > or = 5 seconds. A 20-minute teaching session and demonstration of proper MDI technique was then given. At the end of this session all residents were eventually able to demonstrate proper technique. Two months following this educational session the same house staff physicians were re-evaluated on their MDI technique.
Results:
Initially, ten participants (26%) demonstrated perfect technique. Two months postinstruction the same number of physicians (ten) demonstrated perfect technique. Only six physicians demonstrated perfect technique at both evaluations. Three of the seven steps showed enough change from the first evaluation to the second to permit statistical analysis. Step 4 (timing of actuation) had 11 Physicians' performances improve while three worsened (P=.03). Step 5 (a slow inspiratory effort) had nine physicians' performances improve while three worsened (P=.073). For step 7 (holding the breath > or = 5 seconds), 11 physicians improved while 2 worsened (P=.006). Comparing global performance, there were 17 physicians that improved, 8 that worsened, and 13 with no change (P=.054).
Conclusions:
This study confirmed that many housestaff physicians do not demonstrate optimal MDI technique. While one educational session may somewhat improve their future performance, it is not sufficient to guarantee perfect technique. This suggests that repeated education needs to be given to housestaff physicians.
Insights
A single teaching session improved metered dose inhaler (MDI) technique for some physicians, but perfect technique was not sustained. Repeated education is necessary for housestaff physicians to master MDI use.
Area of Science:
- Medical Education
- Pulmonary Medicine
- Clinical Skills Training
Background:
- Many housestaff physicians exhibit suboptimal technique when using metered dose inhalers (MDIs).
- Improper MDI technique can lead to reduced medication efficacy and poorer patient outcomes.
Purpose of the Study:
- To evaluate the effectiveness of a single educational session on improving housestaff physicians' MDI technique.
- To determine if short-term improvements in MDI technique are maintained over time.
Main Methods:
- Thirty-eight pediatric housestaff physicians were assessed on seven key steps of MDI technique.
- A 20-minute teaching session with demonstration was provided.
- Physicians were re-evaluated two months post-intervention.
Main Results:
- Initially, only 26% of physicians demonstrated perfect MDI technique.
- Two months after the educational session, the percentage of physicians with perfect technique remained unchanged.
- Statistically significant improvements were observed in specific steps, including timing of actuation, inspiratory effort, and breath-holding duration.
Conclusions:
- A single educational intervention is insufficient to ensure sustained, perfect MDI technique among housestaff physicians.
- While some technique aspects improved, overall perfect MDI use was not achieved long-term.
- Repeated and ongoing MDI technique education is recommended for housestaff physicians.
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