USE OF VIDEOTAPING TO EVALUATE PEDIATRIC RESIDENT PERFORMANCE OF HEALTH SUPERVISION EXAMINATIONS OF INFANTS

Study objectives. To demonstrate reliability of a method for evaluatin g pediatric resident performance of health supervision examinations of infants using real patients and to evaluate pediatric resident perfor mance of health supervision examinations of infants before and after a n educational intervention consisting of a 6-month ambulatory rotation combined with video-assisted review of resident performance. of the e xamination. Design. Longitudinal cohort study in which all second-year residents were enrolled. Residents' preintervention (baseline) videot apes were compared with postintervention videotapes. Each resident ser ved as his or her own control. Setting. University hospital pediatric resident continuity clinic. Subjects. Sixteen second-year pediatric re sidents who were participating in a required 6-month ambulatory rotati on. Method and main results. Reliability study: Using a 51-item instru ment derived from the American Academy of Pediatrics Guidelines for He alth Supervision, trained raters blind to the sequence and dates of th e videotaped health supervision examinations independently rated 44 re sident encounters (a minimum of two raters per tape) and achieved good interrater reliability (kappa = 0.80). Intervention study: After a 6- month ambulatory rotation which included resident-faculty reviews of p reintervention videotapes, residents showed a 14% mean improvement in performance scores for the examination (P < .05). Conclusions. The res ults indicate that videotaped health supervision examinations using re al patients can be reliably evaluated by observational techniques in a continuity practice. A 6-month ambulatory block rotation coupled with video-assisted interactive review of examinations is associated with measurable improvement in resident performance on the postintervention test.