Use of “Bug-in-the-Ear” Technology in Improving Pediatric Residents’ Skills in Diagnosis and Treatment of Attention Deficit Hyperactivity Disorder

Objective: To improve pediatric residents’ skills in the diagnosis and treatment of children with Attention Deficit Hyperactivity Disorder (ADHD) by giving real-time feedback utilizing Bug-in-the-Ear technology (BIE). Methods: This prospective, controlled study had two treatment groups and three standardized patient (SP) sessions. Session-1 was baseline. In Session-2, the intervention group (IG) received feedback via BIE and the control group (CG) received traditional feedback. Session-3 (3 months later) assessed maintenance of skills, and neither group used BIE. Sessions were recorded and scored by research assistants trained with a novel scoring system called the Clinical Practice Index (CPI). The CPI is an observational instrument based on current American Academy of Pediatrics (AAP) ADHD guidelines and DSM-5 criteria for ADHD and was reviewed by content experts in ADHD. CPI scores were analyzed using Repeated Measures ANOVA. Results: Twenty-five pediatric residents participated; 13 in the CG and 12 in the IG. Maximum obtainable CPI score was 44 points. The IG showed a significant increase in their CPI score from Session-1 to Session-3 (8.27, P < 0.001). The CG's CPI scores from Session-1 to Session-3 did not change significantly (2.85, P = 0.536). The IG and CG CPI scores were significantly different at Session-2 (11.7, P < 0.001), but not Session-3 (5.03, P = 0.1407). Conclusion: Immediate feedback via BIE showed significant improvement in the IG's skills in Session-2 and the IG's mean difference between Session-1 and Session-3. One exposure of BIE was not sufficient for the IG to maintain their skills, and further research is warranted to determine the number of BIE exposures needed for greater maintenance of skills.