DEFICIENCIES IN CALCULATION AND APPLIED-MATHEMATICS SKILLS IN PEDIATRICS AMONG PRIMARY-CARE INTERNS

Objective: To discover how well new house officers in primary care res idency programs perform the mathematical calculations necessary to fun ction effectively in pediatric and nursery settings. Design: Criterion -referenced survey examination testing unit conversion, fluid and rehy dration management, and drug-dosing skills. Setting: Five primary care residencies in family practice and pediatrics at urban and community campus sites in Illinois. Participants: Twenty-three family practice r esidents and 11 pediatric residents tested during residency orientatio n sessions or in conferences during the first 3 months of training. In terventions: None. Results: The mean score for all residents was 42%. Pediatric residents (mean score, 57.8%) performed significantly better than family medicine residents (mean score, 34.4%) (P=.002). Conversi on from conventional to metric units was more difficult for family pra ctice residents. but pediatric residents also made errors. Pediatric r esidents were significantly better than family medicine residents al c alculation of fluid maintenance requirements (P<.05). Only 5 of 34 res idents wrote acceptable fluid orders. Nutritional and drug therapy cal culations showed fewer mathematical errors, but neither group routinel y wrote medical orders that specified the drug or formula, concentrati on, volume required per dose or feeding, route of administration, dosi ng interval, and duration of therapy. Conclusions: The potential for s erious clinical errors caused by faulty calculation of dosage by house staff officers is high. New residents should have their orders for fl uids and drugs double-checked bg senior personnel early in their train ing. Residency programs should provide remedial skills training for ho use officers with deficiencies in applied mathematics. The medical sch ool faculty needs to assess students' competence in mathematics before allowing independent clinical responsibility.