Study: Medical Students Fail to Measure Blood Pressure Properly

At a recent medical conference (2015 American Medical Association (AMA) Annual Meeting), 159 medical students volunteered to take part in a blood-pressure check challenge. Only one medical student scored 100 percent, and on average, students performed 4.1 of the 11 skills correctly.

Publishing the results last April 2017, researchers found the following error rate on 11 observed skills criteria, …

Only 6.9% of student had the patient rest in the chair for five minutes before taking a measurement.

Only 13.2% of students decided which arm should be used for future readings.

Only 15.1% of medical students made sure the patient placed his or her feet on the floor.

Only 17% of medical students prohibited their patient from using a mobile phone or from reading during the measurement.

Only 18.2% of medical students checked blood pressure in both arms.

Only 15.1% of medical students identified the arm with the higher reading as being more clinically appropriate.

The good news …

83% of medical students properly placed the BP cuff over a bare arm.

73% of medical students selected the correct cuff size.

52.2% of medical students ensured that patient’s legs were uncrossed.

57.2 percent of medical students prohibited the patient from talking during the measurement.

61% of medical students supported the patient’s arm even with the level of the patient’s heart during blood pressure measurement.

The research was constructed so that each medical student went into a mock exam room where a patient actor sat, legs crossed, on an elevated stool with no arm, back or foot support. An empty chair with support for the patient’s back and arms was placed next to the stool. A table that could support the patient’s arm properly was adjacent to the stool and an automated BP monitor, a tape measure and small, medium, large and extra-large BP cuffs were located on the table.

The students were told the patient actor was 50 years-old, new to the medical practice, and had not seen a doctor in several years — a scenario that calls for health professionals to check blood pressure in both arms.

Researchers asked the students to measure the patient’s BP and write down the results. Professional observers evaluated the students in action and passed or failed the medical students on 11 skills.

The results were “disappointing,” study authors said in an article published in The Journal of Clinical Hypertension.

“Given these students represented (medical) schools in 37 states, the results suggest it is unlikely that current U.S. medical students are able to perform reliably the skills necessary to measure BP accurately,” the study authors wrote.

Students in their second through fourth years of medical school scored higher than medical students in their first year of school, but the numbers still showed a need for more training. The older students performed about five of the 11 tasks properly versus the younger students when nearly four out of 11 tasks were performed properly.

“We believe the use of automated devices will reduce some common errors in measuring BP, but our study confirms that automated device use alone will not eliminate many common errors in BP measurement,” the study authors concluded. “Medical school training in these skills should be revised and studied to ensure it is effective.”

The authors also called for physicians to undergo competency testing at a minimum of every six months throughout their careers, which is what other health care professionals recommended in their fields.

BP measurement is well known as the most common procedure in clinical practice, and accuracy is key to delivering quality care, study authors said. Improving blood-pressure control could save more lives than any other clinical intervention, said former Centers for Disease Control and Prevention Director Thomas Frieden, MD, in 2015.

Target: BP™ is a national initiative co-led by the American Heart Association and the AMA, and started in 2015.

Target: BP supports health care facilities by offering …

tools, resources and improvement plans, including a customizable algorithm with proven efficacy;

best practices and success stories from other Target: BP participants; and

easy-to-use tools and resources to help patients better understand the importance of controlling blood pressure.

In addition to direct access to trained field support specialists, a data platform and a suite of evidenced-based tools and resources offered by the AMA and the AHA, Target: BP offers annual, recurring recognition for all participating sites that achieve hypertension control rates of 70 percent or higher among their adult patient population year over year.

Rakotz MK1, Townsend RR2, Yang J1, Alpert BS3, Heneghan KA1, Wynia M4, Wozniak GD1. Medical students and measuring blood pressure: Results from the American Medical Association Blood Pressure Check Challenge. J Clin Hypertens (Greenwich). 2017 Apr 28. doi: 10.1111/jch.13018.

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