title: Pediatric residents' performance of ankle and knee examinations after an educational intervention.
abstract: BACKGROUND
  Pediatric residents have the need for additional training in the care of common musculoskeletal injuries.
  
  
  OBJECTIVE
  To implement and evaluate the effects of a teaching intervention on pediatric residents' knowledge and skills in performing the physical examination of the ankle and knee.
  
  
  METHODS
  Prospective, intervention, single-sample study design.
  
  
  METHODS
  Pediatric residents (n = 58) on a 1-month adolescent medicine rotation received a teaching intervention after a baseline evaluation of their knowledge and skills. The teaching intervention was designed to improve their knowledge about and skills in performing physical examinations of the ankle and knee. The intervention included watching a videotape, followed by observation of the attending physician demonstrating the techniques on a standardized patient, followed by correct demonstration of the techniques by the resident. The residents' knowledge and skills were assessed at the end of the rotation and 9 months later. Knowledge was assessed using a written examination. Skills assessment was performed using a Clinical Skills Assessment Examination.
  
  
  RESULTS
  At baseline, the residents performed 37% of the ankle and 18% of the knee physical examination techniques correctly. At 1 and 9 months, the residents' knowledge of ankle and knee examinations was greater than at baseline. The residents performed 77% of the techniques correctly at 1 month and 67% at 9 months. The residents performed 55% of the knee examination techniques correctly at 1 month and 47% at 9 months. The teaching intervention was rated highly by the residents.
  
  
  CONCLUSIONS
  The residents' performance of ankle and knee examinations was suboptimal at baseline and improved significantly after the teaching intervention. Observed improvements persisted for a mean of 35 weeks. The teaching intervention described in this study could meet the need for improved ankle and knee examination skills, the 2 most common sites of skeletal injury in young athletes. The teaching model is novel in that it couples videotape and skills-based teaching methods with reliable evaluation methods. This model teaching method could be adapted for use in other pediatric residency training programs and other content areas. musculoskeletal, physical examination, resident curriculum.
authors.affiliation: Department of Pediatrics, Adolescent Medicine and Sports Medicine Section, Baylor College of Medicine, Houston, Texas 77030-2399, USA. alberth@bcm.tmc.edu
authors.forename: A C
authors.initials: AC
authors.lastname: Hergenroeder
authors.forename: J N
authors.initials: JN
authors.lastname: Chorley
authors.forename: L
authors.initials: L
authors.lastname: Laufman
authors.forename: A C
authors.initials: AC
authors.lastname: Fetterhoff
mesh_terms: D000295:Adolescent Medicine / Q000193:education; D016512:Ankle Injuries / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards; D003479:Curriculum; D004521:Educational Measurement / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency / Q000592:standards / Q000706:statistics & numerical data*; D007718:Knee Injuries / Q000175:diagnosis*; D010372:Pediatrics / Q000193:education*; D010808:Physical Examination / Q000379:methods* / Q000592:standards; D011446:Prospective Studies; D012073:Remedial Teaching / Q000379:methods; D013178:Sports Medicine / Q000193:education; D013663:Teaching