Standardized Checklist for Otoscopy Performance Evaluation: A Validation Study of a Tool to Assess Pediatric Otoscopy Skills

INTRODUCTION: Acute otitis media (AOM) is the most frequently diagnosed pediatric illness in the United States and the most common indication for antibiotic prescription. Skill in pediatric otoscopy is essential to correctly identify children with AOM. However, studies have found diagnostic inconsistency and significant overdiagnosis among practitioners. Given the potential public and individual health consequences, there has been a call for improved education regarding the diagnostic certainty of AOM. Yet educational efforts continue to be limited, particularly in regard to competency assessment. The lack of a validated tool to assess otoscopy skill attainment objectively diminishes the instructor's ability to provide useful feedback and direction to the learner. METHODS: We have undertaken an educational intervention with the goal of developing a validated Standardized Checklist for Otoscopy Performance Evaluation (SCOPE), building on key principles of the general pediatric ear exam. The SCOPE was developed with the input of process and content experts with attention to specific domains of validity. RESULTS: Our analysis provides important validity evidence for the SCOPE assessment tool. The instrument was piloted and successfully implemented with medical students and varying levels of residents in pediatrics and emergency medicine over a 5-year period in varied settings: urgent care, large and small pediatric clinics, and the emergency departments at two institutions. It has been used for both instruction and assessment purposes. DISCUSSION: Because the SCOPE can be used in teaching demonstration purposes, in formative and summative assessment settings, and across the continuum of learners, this instrument offers the potential for more educational efforts in the field of assessment in direct patient care. We anticipate that the SCOPE will foster an environment of efficient yet high-yield review and discussion of otoscopy and diagnostic competency.