J Clin Hypertens. 2018;20:609–610. wileyonlinelibrary.com/journal/jch
©2018 Wiley Periodicals, Inc.
LETTER TO THE EDITOR
Medical students’ proficiency in performance of the resting
ankle- brachial index is not sustained at 6 months
We read with interest the paper by Rakotz et al relating the poor profi-
ciency of medical students on an 11- element skillset to blood pressure
BP measurement is also a basis of the ankle- brachial
index (ABI) at rest that is the first- line test to diagnose peripheral artery
disease (PAD), a disease affecting over 200 million individuals world-
ABI proposed by Winsor is defined as the ratio of the highest sys-
tolic BP measured at the ankle to that measured at the brachial artery.
PAD screening is proposed by international guidelines and screening has
shown to be cost- effective.
Thereby, one might assume that checking
ABI would be at the top of the list of medical student proficiencies. A
follow- up study conducted according to ethics review board (n°16.150)
sought to evaluate the retention of ABI procedure among French medical
students 6 months after the teaching. Indeed, we previously conducted
a randomized control trial (RCT) which confirmed that (1) didactic learn-
ing alone is insufficient to ensure medical students performance of the
ABI and (2) a didactic learning associated with 3 experiential learning
sessions significantly improved the students’ proficiency compared with
didactic learning alone.
The methods have been extensively described
In this follow- up study we highlighted that medical students
fail to retain ankle- brachial index skills. At 6 months, a significant differ-
ence was found compared with the number of students proficient in ABI
procedure at the end of the learning procedure (Figure).
This study shows that without training on ABI between the two
evaluations the medical students proficiency is not sustained. This
questions: (1) how can we maintain the medical students’ proficiency
in performance of ABI and (2) whether ABI measurement should be
taught in medical schools for non- vascular specialist students since
the proficiency is not sustained in medical students. Furthermore, this
study strengthens the ideas that the current medical school curricu-
lum needs to be redesigned as already suggested.
alone should be stopped or reinforced with experiential learning and
competency testing should be carried out regularly to check retention.
S. Chaudru has received a grant from the region “Bretagne” (Bourse
CONFLICT OF INTEREST
The authors report no specific funding in relation to this research and
no conflicts of interest to disclose.
Guillaume Mahe http://orcid.org/0000-0003-1318-4745
Céline Donnou MD
Ségolène Chaudru MSc
Olivier Stivalet MD
Eunice Paul MD
Marie Charasson MD
Jean-Marc Selli MD
Chadi Mauger MD
Anthony Chapron MD, PhD
Alexis Le Faucheur PhD
Vincent Jaquinandi MD, PhD
Loukman Omarjee MD
Guillaume Mahe MD, PhD
CHU Rennes, CIC 1414, INSERM, Univ Rennes, Rennes, France
Movement, Sport and Health laboratory, EA 1274, UFR APS, Université
de Rennes 2 (Rennes 2 University), Rennes, France
Department of Sport Sciences and Physical Education, Campus de Ker
Lann Ecole, Normale Supérieure de Rennes, Bruz, France
1. Rakotz MK, Townsend RR, Yang J, et al. Medical students and measuring
blood pressure: results from the American medical association blood
pressure check challenge. J Clin Hypertens. 2017;19:614-619.
FIGURE Medical students’ proficiency in the performance of
ankle brachial index. RCT means randomized controlled trial