Improving assessment of paediatric acute breathing difficulties in medical education: a cluster randomized controlled trial



Logan Manikam MBcHB; University of Leicester, 26 West Avenue, LE2 1TR, Leicester, UK.

Tel: +7868721152 or +1162745838 |




Impact assessment of an adjunct to standard teaching on knowledge gain and self-assessed confidence for students undertaking their paediatric attachment and evaluation of an acute breathing difficulties (ABDs) learning package.


Pragmatic cluster randomized controlled trial involving 248 UK medical undergraduates within six paediatric clinical rotations. Intervention groups received an online ABD learning package consisting of symptom-based decision-making pathways underpinned by a ratified ABD evidence-based guideline. Control groups received an online dummy package. Outcome measures were a pre- and post-intervention multiple choice question assessment and confidence questionnaire utilising 5-point Likert scales.


Significant knowledge gain in the intervention group (mean 6.84, 95% CI 5.56-8.12) versus no such difference in the control group, significant improvement in self-assessed confidence in intervention group versus no such difference in control group and significant confidence differences in ABD-specific statements were noted. In the satisfaction questionnaire, the learning content was noted to be new to only 16% participants.


Supplementation of standard teaching with an interactive delivery method resulted in cognitive gain and self-assessed confidence improvement in interaction with children with ABDs. This indicates that a well-designed tool can help prepare students for direct interaction with sick children as a junior clinician. Trial Registration: ISRCTN27499282.