title: Physicians' metered dose inhaler technique after a single teaching session.
abstract: 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.
authors.affiliation: Department of Pediatrics, Division of Allergy, Columbia Presbyterian Medical Center, New York 10032, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Resnick
authors.forename: R L
authors.initials: RL
authors.lastname: Gold
authors.forename: M
authors.initials: M
authors.lastname: Lee-Wong
authors.forename: B R
authors.initials: BR
authors.lastname: Feldman
authors.forename: R
authors.initials: R
authors.lastname: Ramakrishnan
authors.forename: W J
authors.initials: WJ
authors.lastname: Davis
mesh_terms: D000280:Administration, Inhalation; D000486:Allergy and Immunology / Q000193:education*; D001249:Asthma / Q000188:drug therapy*; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D009330:Nebulizers and Vaporizers