Medical students and measuring blood pressure: Results from the American Medical Association Blood Pressure Check Challenge

Michael K Rakotz, Raymond R Townsend, Jianing Yang, Bruce S Alpert, Kathleen A Heneghan, Matthew Wynia, Gregory D Wozniak, Michael K Rakotz, Raymond R Townsend, Jianing Yang, Bruce S Alpert, Kathleen A Heneghan, Matthew Wynia, Gregory D Wozniak

Abstract

Blood pressure (BP) measurement is the most common procedure performed in clinical practice. Accurate BP measurement is critical if patient care is to be delivered with the highest quality, as stressed in published guidelines. Physician training in BP measurement is often limited to a brief demonstration during medical school without retraining in residency, fellowship, or clinical practice to maintain skills. One hundred fifty-nine students from medical schools in 37 states attending the American Medical Association's House of Delegates Meeting in June 2015 were assessed on an 11-element skillset on BP measurement. Only one student demonstrated proficiency on all 11 skills. The mean number of elements performed properly was 4.1. The findings suggest that changes in medical school curriculum emphasizing BP measurement are needed for medical students to become, and remain, proficient in BP measurement. Measuring BP correctly should be taught and reinforced throughout medical school, residency, and the entire career of clinicians.

Keywords: blood pressure measurement; competency training; hypertension; medical students.

Conflict of interest statement

Bruce Alpert is a consultant with Cordex.

© 2017 American Medical Association. Journal of Clinical Hypertension published by Wiley Periodicals, Inc.

References

    1. Frieden TR. The future of public health. N Engl J Med. 2015;373:1748‐1754.
    1. Jaffe MG, Young JD. The Kaiser Permanente Northern California story: improving hypertension control from 44% to 90% in 13 years (2000 to 2013). J Clin Hypertens (Greenwich). 2016;18:260‐261.
    1. Rabbia F, Testa E, Rabbia S, et al. Effectiveness of blood pressure educational and evaluation programs for the improvement of measurement accuracy among nurses. High Blood Press Cardiovasc Prev. 2013;20:77‐80.
    1. Pickering T, Hall JE, Appel LJ, et al. Recommendations for blood pressure measurement in humans and experimental animals part 1: blood pressure measurement in humans – a statement for professionals from the Subcommittee of Professional and Public Education of the American Heart Association Council on High Blood Pressure Research. Hypertension. 2005;45:142‐161.
    1. Grim CE, Grim CM, Li J. Entering medical students who say they have been trained to take blood pressure do not follow American Heart Association guidelines. Am J Hypertens. 1999;12:122A.
    1. Gonzalez‐Lopez JJ, Gomez‐Arnau Ramirez J, Garcia RT, et al. Knowledge of correct blood pressure measurement procedures among medical and nursing students. Rev Esp Cardiol. 2009;62:568‐571.
    1. Bland M, Ousey K. Preparing students to competently measure blood pressure in the real‐world environment: a comparison between New Zealand and the United Kingdom. Nurse Educ Pract. 2012;12:28‐35.
    1. Gazibara T, Rancic B, Maric G, et al. Medical students, do you know how to measure blood pressure correctly? Blood Press Monit. 2015;20:27‐31.
    1. Alimoglu MK, Mamakli S, Gurpinar E, Aktekin M. Medical students lose their competence in clinical skills if not applied on real patients: results of two‐year cohort study. Turkiye Klinkikleri J Med Sci. 2011;31:1356‐1363.
    1. Crosley AM, La Rose JR. Knowledge of accurate blood pressure measurement procedures in chiropractic students. J Chiropr Educ. 2013;27:152‐157.
    1. Bottenberg MM, Bryant GA, Haack SL, North AM. Assessing pharmacy students’ ability to accurately measure blood pressure using a blood pressure simulator arm. Am J Pharm Educ. 2013;77:98.
    1. Weber MA, Schiffrin EL, White WB, et al. Clinical practice guidelines for the management of hypertension in the community: a statement by the American Society of Hypertension and the International Society of Hypertension. J Hypertens. 2014;32:3‐15.
    1. Leung AA, Nerenberg K, Daskalopoulou S, et al. Hypertension Canada's 2016 CHEP guidelines for blood pressure measurement, diagnosis, assessment of risk, prevention and treatment of hypertension. Can J Cardiol. 2016;32:569‐588.
    1. Mancia G, Fagard R, Narkiewicz Krzysztof, et al. ESH/ESC Guidelines for the management of arterial hypertension. Euro Heart J. 2013;2013:2159‐2219.
    1. Vidt DG, Lang RS, Seballos RJ, et al. Taking blood pressure: too important to trust to humans. Cleve Clin J Med. 2010;77:683‐688.
    1. Bickley LS, Szilagyi PG. Beginning the physical examination: general survey, vital signs and pain. In: Bickley LS, Szilagyi PG, eds. Bates’ Guide to Physical Examination and History Taking, 11th ed. Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams and Wilkins; 2013:119‐134.
    1. Graves J, Sheps S. Does evidence‐based medicine suggest that physicians should not be measuring blood pressure in the hypertensive patient. Am J Hypertens. 2004;17:354‐360.
    1. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on prevention, detection, evaluation and treatment of high blood pressure. Hypertension. 2003;42:1206‐1252.
    1. Grim CM, Grim CE. A curriculum for the training and certification of blood pressure measurement for healthcare providers. Can J Cardiol. 1995;11 (suppl H):38H‐42H.
    1. Sebo P, Pechere‐Bertschi A, Herrmann F, Haller D, Bovier P. Blood pressure measurements are unreliable to diagnose hypertension in primary care. J Hypertens. 2014;32:509‐517.

Source: PubMed

Подписаться