Simulation-based training improves developmental hip dysplasia examination and diagnosis skills on newborns.

Abstract

Background: Examination maneuvers used to diagnose developmental hip dysplasia (DDH) translate poorly to video and written curricula. This poses a challenge to teaching the infant hip exam to orthopedic, family medicine, and pediatric trainees. This work investigated the impact of the MiHip simulation-based training program on residents' knowledge, confidence, and exam skills in the simulated setting, and translation of these skills to the clinical setting.

Methods: Fifty-four pediatric (n=39) and family medicine (n=15) residents participated in a non-randomized, stepped-wedge study during 2-4 week newborn rotations. Residents participated in simulation-based training facilitated by a pediatric orthopedic surgeon. Prior to and following training, residents completed a 10-item quiz and reported their confidence toward their DDH skills. Residents' and attendings' hip exam diagnoses were captured on 1,063 newborns. Residents' knowledge, confidence, and DDH diagnosis sensitivity were compared pre- and post-training. Chart analysis of 21 newborns that underwent a hip ultrasound compared residents' and practicing physicians' diagnoses' agreement with ultrasound findings.

Results: Following training, residents' knowledge, confidence and diagnosis skills improved modestly, P<0.001. In the clinical setting, residents' confidence (P<0.001) and skill improved for residents with (sensitivity Δ=.29) and without (Δ =.18) previous simulation-based training experience. Resident diagnoses demonstrated higher agreement with hip ultrasounds than practicing primary care physicians, (M_trainee=88.9%, M_PCP=25.0%, P = 0.003, φ=.63).

Conclusion: The hands-on training with the MiHip simulator improved resident knowledge and DDH examination confidence, and ultimately, improved diagnostic accuracy in the clinical setting. Further work is required to assess the larger clinical impact on orthopedic referral rates.