Mastering Diagnostic Skills: Enhancing Proficiency in Otitis Media, a Model for Diagnostic Skills Training

OBJECTIVE: We developed a program for training in the diagnosis of otitis media that included images illustrating various otoscopic findings, mnemonic guides to recollection, and discrimination sessions that included feedback and assessments of diagnostic skills. METHODS: We prepared a computerized, interactive curriculum, Enhancing Proficiency in Otitis Media (ePROM), that was centered around assemblages of clinically diverse, still and video images of tympanic membranes (TMs). To assess curriculum effectiveness, we constructed a test, the Diagnostic Ear Assessment Resource, that consisted of 50 video TM images. We administered the test to 84 residents in pediatrics or family practice who had not been exposed to ePROM and, varying the order in which the images were presented, to another group of 102 residents in the same programs both before and after exposure to ePROM. RESULTS: Mean proportions of correct diagnoses in the Diagnostic Ear Assessment Resource were larger among residents who had been exposed to ePROM than among residents at comparable levels of training who had not been exposed (67% vs 62%; P = .007). Among residents exposed to ePROM, mean proportions of correct diagnoses were larger after exposure than before (67% vs 55%; P < .001). CONCLUSION: A structured, computerized curriculum to supplement standard clinical training can enhance residents' abilities to interpret still and video images of TMs and may improve their skills in diagnosing otitis media. Pediatrics 2009; 124: e714-e720