Spiral Integrated Competency Concussion Education: Pre-then-Post Design for Self-Awareness

Research Objectives: To investigate whether pre-then-post design is valuable as a training tool to foster self-awareness of confidence level in a spiral integrated concussion curriculum.

Design: Cross-sectional survey.

Setting: Family medicine residency program (n=32) at University of Toronto, Ontario, Canada.

Participants: Eight first- and second-year family medicine residents who completed the survey as part of a concussion education program from 2021 to 2022.

Interventions: We implemented a spiral integrated competency concussion curriculum. In this study, we implemented this pre-then-post design following three half-day competency-based physiatry concussion clinics.

Main Outcome Measures: At the end of clinics, we investigated residents’ self-reported changes in confidence level utilizing the pre-then-post design, on a five-point Likert scale from the survey. The self-reported confidence was itemized into different components consisting of history taking, physical examination, diagnosis, and management.

Results: Eight participants completed the survey and showed a 32% increase in their overall confidence (95% CI: (0.40, 1.40), p=0.004). All sub-components showed improvements (history taking: 39% (n=8, 95% CI: (0.44, 1.60), p=0.004); physical examination: 24% (n=7, 95% CI: (0.08, 1.44), p=0.034); diagnosis: 34% (n=7, 95% CI: (0.44, 1.56), p=0.005); management: 48% (n=7, 95% CI: (0.55, 1.80), p=0.004)).

Conclusions: Our pilot pre-then-post design showed that the residents' confidence level for concussion increased, with concussion management improving the most. The change in subjective confidence level implies that pre-then-post design may potentially foster residents’ self-awareness. Future comparison study would be useful to explore the impacts of the pre-then-post design.

Author(s) Disclosures: None.