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Video and CD-ROM as a Training Tool for Performing Neurologic Examinations of 1-Year-Old Children in a Multicenter Epidemiologic Study

Division of Pediatric Neurology, Department of Pediatrics, Boston Medical Center, Boston University, Boston, MA, Karl.Kuban{at}bmc.org

Michael O'Shea, MD, MPH

Department of Neonatology, Wake Forest University, Winston-Salem, NC

Elizabeth Allred, MS

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA, Department of Biostatistics, Harvard School of Public Health, Harvard University, Boston, MA

Alan Leviton, MD

Neuroepidemiology Unit, Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA

Herbert Gilmore, MD

Baystate Medical Center, Tufts University School of Medicine, Springfield, MA

Adré DuPlessis, MBChB, MPH

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA, Brigham and Women's Medical Center, Harvard University, Boston, MA

Kalpathy Krishnamoorthy, MD

Massachusetts General Hospital

Cecil Hahn, MD, FRCPC

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA

Janet Soul, MD, CM

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA, Brigham and Women's Medical Center, Harvard University, Boston, MA

Sunila E. O'Connor, MD

University of Chicago, Chicago, IL

Karen Miller, MD

Tufts-New England Medical Center

Paige T. Church, MD

Tufts-New England Medical Center

Cecilia Keller, PT, MHA

Tufts-New England Medical Center

Richard Bream, MD

University of Massachusetts Memorial Medical Center, Worcester, MA

Robin Adair, MD

University of Massachusetts Memorial Medical Center, Worcester, MA

Alice Miller, PT, MS

University of Massachusetts Memorial Medical Center, Worcester, MA

Elaine Romano, MSN

Yale University Medical Center

Haim Bassan, MD

Department of Neurology, Children's Hospital Boston, Harvard University, Boston, MA

Kathy Kerkering, MD

East Carolina University

Steve Engelke, MD

East Carolina University

Diane Marshall, MD, MPH

University of North Carolina

Kristy Milowic, MD

University of North Carolina

Janice Wereszczak, CPNP, MSN

University of North Carolina

Carol Hubbard, RN, MSN, CPNP

University of North Carolina

Lisa Washburn, MD

Department of Neonatology, Wake Forest University, Winston-Salem, NC

Robert Dillard, MD

Department of Neonatology, Wake Forest University, Winston-Salem, NC

Cherrie Heller, MD

Department of Neonatology, Wake Forest University, Winston-Salem, NC

Wendy Burdo-Hartman, MD

DeVos Children's Hospital

Lynn Fagerman, MSN, APRN-BC, PNP

DeVos Children's Hospital

Dinah Sutton, RN

DeVos Children's Hospital

Padu Karna, MBBS

Michigan State University-Sparrow Medical Center

Nick Olomu, MBBS

Michigan State University-Sparrow Medical Center

Leslie Caldarelli, MD

University of Chicago, Chicago, IL

Melisa Oca, MD

William Beaumont Hospital, Neonatal Unit, Royal Oak, MI

Kim Lohr, MSN

DeVos Children's Hospital

Albert Scheiner, MD

University of Massachusetts Memorial Medical Center, Worcester, MA

In lieu of traditional training of examiners to identify cerebral palsy on a neurologic examination at age 1 year, we proposed an alternative approach using a multimedia training video and CD-ROM we developed after a two-step validation process. We hypothesized that use of CD-ROM interactive training will lead to reliable and valid performance of the neurologic examination by both pediatric neurologists and nonpediatric neurologists. All examiners were asked to take one of six interobserver variability tests found on the CD-ROM on two occasions. In the first interobserver variability evaluation, 89% (531 of 594) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the two items that had a 60% correct rate, the correct response rate rose to 93% (114 of 123). In the second interobserver variability evaluation, 88% (493 of 560) of the responses agreed with the gold standard responses. Following annotated feedback to the examiners about the four items that had a 70% correct rate, the correct response rate rose to 96% (104 of 108). Interactive CD-ROM examination training is an efficient and cost-effective means of training both neurologists and non-neurologists to perform structured neurologic examinations in 1-year-old children. It provides an effective means to evaluate interobserver variability, offers a route for feedback, and creates an opportunity to reevaluate variability, both immediately and at periodic intervals. (J Child Neurol 2005;20:829—831).

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