Assessing resident diagnostic skills using a modified bronchiolitis score

ORIGINAL ARTICLE

Assessing Resident Diagnostic Skills Using a Modified Bronchiolitis Score

Andrea Rivera-Sepulveda^1,2, Muguette Isona³.

¹Department of Pediatrics, Emergency Medicine, Nemours Children’s Hospital, Orlando, FL, United States,
²University of Puerto Rico Medical Sciences Campus, School of Health Professions and School of Medicine, San Juan, Puerto Rico,
³Emergency Department, San Juan City Hospital, San Juan, Puerto Rico.

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Abstract
Background: Resident milestones are objective instruments that assess the resident’s growth, progression in knowledge, and clinical diagnostic reasoning; but they rely on the subjective appraisal of the supervising attending. Little is known about the use of standardized instruments that may complement the evaluation of resident diagnostic skills in the academic setting.
Objectives: Evaluate a modified bronchiolitis severity assessment tool by appraising the inter-rater variability and reliability between pediatric attendings and pediatric residents.
Methods: Cross-sectional study of children under 24 months of age who presented to a Community Hospital’s Emergency Department with bronchiolitis between January-June 2014. A paired pediatric attending and resident evaluated each patient. Evaluation included age-based respiratory rate (RR), retractions, peripheral saturation, and auscultation. Cohen's kappa (K) measured inter-rater agreement. Inter-rater reliability (IRR) was assessed using a one-way random, average measures intra-class correlation (ICC) to evaluate the degree of consistency and magnitude of disagreement between inter-raters. Value of >0.6 was considered substantial for kappa and good internal consistency for ICC.
Results: Twenty patients were evaluated. Analysis showed fair agreement for the presence of retractions (K=0.31), auscultation (K=0.33), and total score (K=0.3). The RR (ICC=0.97), SpO2 (ICC=1.0), auscultation (ICC=0.77), and total score (ICC=0.84) were scored similarly across both raters, indicating excellent IRR. Identification of retractions had the least agreement across all statistical analysis.
Conclusion: The use of a standardized instrument, in conjunction with a trained resident-teaching staff, can help identify deficiencies in clinical competencies among residents and facilitate the learning process for the identification of pertinent clinical findings.

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