title: Using a novel assessment of procedural proficiency provides medical educators insight into blood pressure measurement.
abstract: OBJECTIVE
  This investigation was performed to determine how students in a health sciences program utilize and explain techniques within blood pressure measurement using a novel assessment, and changes associated with greater curricular exposure.
  
  
  METHODS
  An exploratory, qualitative and quantitative study was conducted using a 'Think Aloud' design with protocol analysis. Following familiarization, participants performed the task of measuring blood pressure on a reference subject while stating their thought processes. A trained practitioner recorded each participant's procedural proficiency using a standardized rubric. There were 112 participants in the study with varying levels of curricular exposure to blood pressure measurement.
  
  
  RESULTS
  Four trends are noted. Specifically, a trend was observed wherein a marked increase in procedural proficiency with a plateau occurred (e.g. released cuff pressure 2-4 mmHg, 10%, 60%, 83%, 82%). Secondly, a trend was observed with improvement across groups (e.g. cuff placed snugly/smoothly on upper arm, 20%, 60%, 81%, and 91%). Other trends included a marked improvement with subsequent decrease, and an improvement without achieving proficiency (e.g. palpation of the brachial pulse, 5%, 90%, 81%, 68%, appropriate size cuff, 17%, 40%, 33%, 41%, respectively). Qualitatively, transcript interpretation resulted in a need for clarification in the way blood pressure procedure is instructed in the curriculum.
  
  
  CONCLUSIONS
  The current investigation provides a snapshot of proficiency in blood pressure assessment across a curriculum and highlights considerations for best instructional practices, including the use of Think Aloud. Consequently, medical educators should use qualitative and quantitative assessments concurrently to determine achievement of blood pressure skill proficiency.
authors.affiliation: Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Holmstrup
authors.affiliation: Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA.
authors.forename: Brock
authors.initials: B
authors.lastname: Jensen
authors.affiliation: Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Burkart
authors.affiliation: Department of Exercise and Rehabilitative Sciences, Slippery Rock University, Slippery Rock, PA, USA.
authors.forename: Malorie
authors.initials: M
authors.lastname: Levis
mesh_terms: D001795:Blood Pressure Determination / Q000379:methods / Q000592:standards; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods* / Q000592:standards; D004521:Educational Measurement / Q000379:methods*; D005180:Faculty, Medical / Q000458:organization & administration; D006801:Humans; D033262:Narration; D013337:Students, Medical; D013850:Thinking
keywords: instructional methods; interdisciplinary medical education; qualitative research methods; think aloud