Abstract Details

Title Targeted Didactic Improves Neurology and Emergency Medicine Resident Competency in the Head Impulse, Nystagmus, and Test of Skew (HiNTs) Exam

Topic Research Methodology, Education, and History

Presentation(s) Research Methodology and Education Posters (7:00 AM-5:00 PM)

Poster/Presentation
Number 049

Background The HiNTS exam is a validated three-part bedside exam to distinguish central from peripheral vertigo. There is little literature on the knowledge and education of the HiNTs exam among EM and neurology trainees.

Objective To evaluate the need for teaching regarding the Head Impulse, Nystagmus, and Test of Skew (HiNTS) exam and effectiveness of a didactic session for neurology and emergency medicine (EM) residents.

Design/Methods EM and neurology residents at UC San Diego Health participated in an interactive lecture-based didactic. The curriculum, developed with the neurology program director, focused on 1) patient selection and technical performance of HiNTs exam 2) peripheral vertigo mimics. Residents completed a pre- and post-didactic multiple choice knowledge test and subjective survey (Likert, 1 [very uncomfortable] to 5 [very comfortable]). T-test and 2-tailed Wilcoxon signed rank test used for statistical analysis (p<.05).

Results A total of 8 neurology and 6 EM residents (n =14) participated; of these 35% (5/14) of residents were in their final year of training. Pre-didactic, 78% (11/14) of participants agreed more training would be beneficial. There was no significant difference in pre-test knowledge or comfort between ED and neurology residents. Residents had the most difficulty distinguishing syncope from vertigo and interpreting HiNTS exams with no clinical findings. There was improvement across all self-competency measures (mean): comfort in vertigo diagnosis (3.4 [neutral] to 4.2 [comfortable]), comfort in steps of the HiNTs exam (3.5 to 4.3), and comfort with independently performing the HiNTs exam (3.7 to 4.2). Objective test scores improved from 67% to 80% after didactic (p<.05). All residents found the curriculum beneficial.

Conclusions We identified deficiencies regarding the HiNTs exam in both neurology and EM residents. A short didactic improves knowledge and subjective comfort with HiNTs exam and vertigo diagnosis.

Authors/Disclosures
Julia T. Bu, MD (UCSD) PRESENTER	Dr. Bu has nothing to disclose.
Dolores Torres, MD (Community Neuroscience Institute)	Dr. Torres has nothing to disclose.
Leena Kansal, MD (UC San Diego Health, Neurosciences)	Dr. Kansal has nothing to disclose.
Patrick M. Chen, MD (UC Irvine Medical Center)	Dr. Chen has nothing to disclose.