At a recent medical conference, 159 medical students volunteered to take part in a blood-pressure check challenge. Individually, students 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 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 sat on the table.
The students were told the patient actor was 50 years old, new to the 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 them on 11 skills.
The results were “disappointing,” study authors said in an article published in The Journal of Clinical Hypertension. Just one student scored 100 percent. On average, students performed 4.1 of the 11 skills correctly. The “Blood Pressure Check Challenge” was held at the 2015 AMA Annual Meeting.
“Given these students represented 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.
Most often, students did not have the patient rest in the chair for five minutes before taking a measurement, with just 6.9 percent of students remembering to do this. There were five other areas where fewer than 20 percent of students performed the skill correctly: deciding which arm should be used for future readings (13.2 percent); ensuring the patient placed his or her feet on the floor (15.1 percent) not allowing the patient to use a mobile phone or read during the measurment (17 percent); checking blood pressure in both arms (18.2 percent); and when asked, identifying the arm with the higher reading as being more clinically appropriate (15.1 percent).
Students were best at placing the cuff over a bare arm (83 percent) and selecting the correct cuff size (73.6 percent). In three areas, about half of students did well: ensuring a patient’s legs were uncrossed (52.2 percent); not allowing the patient to talk during the measurement (57.2 percent) and supporting the patient’s arm at heart level (61.0 percent).
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 correctly versus the younger students nearly four out of 11 tasks being properly performed.
“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 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, former Centers for Disease Control and Prevention Director Thomas Frieden, MD, said in 2015. And national movements are recognizing the importance of making strides to improve blood-pressure control in patients.
The Million Hearts Hypertension Control Challenge is a federal competition to identify clinicians, practices and health systems that have achieved a hypertension control rate of 70 percent or greater among their patients with hypertension and award them with recognition for their work.
Target: BP™ is a national initiative co-led by the American Heart Association and the AMA. 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.
