Evaluating effectiveness of educational intervention on syphilis screening and interpretation in a Family Medicine Residency

Context: multiple episodes of inappropriate interpretation and subsequent management of abnormal syphilis screening results were noted in our Family Medicine Residency Clinic (FMRC)

Objective: develop an educational intervention to inform about appropriate interpretation of syphilis screening and subsequent management with an assessment of understanding and confidence in interpreting, managing, and teaching this content

Study Design and Analysis: a 6-month pre-intervention review of syphilis screening results in the FMRC to assess interpretation and management of abnormal results. A lecture was given to residents and faculty with a pre and post-intervention survey including a brief quiz about interpretation and management of syphilis results as well as assessment of confidence in performing same as well as teaching this content. A copy of the presentation was provided for those unable to attend to enhance participation in the survey. Post-intervention data was queried from the FMRC and reviewed for any change in pattern in interpretation and management. A t-test and discrimination index was performed to evaluate responses to the survey with descriptive statistics, Chi-square and Fisher Exact test performed on chart review data.

Setting: Urban Family Medicine residency clinic

Population Studied: residents and faculty of a Family Medicine residency, patients in the Family Medicine residency clinic where residents and faculty evaluated practice

Intervention: educational lecture on syphilis testing interpretation and management

Outcome Measures: responses to knowledge assessment and confidence pre and post-intervention. Improved interpretation and management of syphilis screening results after intervention

Results: Survey questions assessing knowledge had variable performance with net poor discrimination after the educational intervention. Confidence in all measures improved post-intervention but were not statistically significant. There were no significant differences in appropriate versus inappropriate evaluation and management and comparing reactive versus nonreactive results pre versus post-intervention. Post-hoc power analysis for appropriate versus inappropriate diagnosis and management was very low (2.7% and 31.8% respectively).

Conclusions: While a non-significant incidence in reactive syphilis screening may reflect better understanding and application of screening this intervention performed poorly likely due to small sample size.