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Center for Advancement of Osteopathic Research Methodologies

Advancing Medical Student Accuracy and Reliability Performance of Pelvic Positional Asymmetry Tests through Consensus Training and Objective Feedback. 

SRI Scientists

  • Brian Degenhardt, DO
  • Eric Snider, DO
  • Ken Pamperin, MS
  • Vanessa Pazdernik, MS

Purpose and Aims

This study quantifies if students after completing their first year of osteopathic medical school can accurately observe bony landmark asymmetries.  There are 3 stages in this study. In stage 1, calibrated pelvic models are used as the gold standard to determine the accuracy of examiners’ diagnosis of positional asymmetry of pelvic landmarks.  Four examiners evaluate each landmark in a blinded fashion 12 times for each asymmetry setting (1-6 mm).  Reference and reflective markers on the examining digits are used to quantify the degree of asymmetry between the digits using the Digital Camera Measurement System (DCMS) and the Vicon Peak 3-D Motion Capturing System.  Instrument data is processed by the research team to provide the students objective feedback for refining their skills.

In stage 2, the examiners evaluate positional asymmetry of pelvic landmarks on 20 adult volunteers using refined techniques developed in stage 1.  Each examiner provides a blinded assessment of pelvic landmark asymmetry.  After every 2 subjects, consensus training takes place when disagreements occur between examiner findings and DCMS images or between the examiners findings.  Interexaminer reliability is then assessed for the student group.

In stage 3, as a means of performing a definitive evaluation of the interexaminer reliability of positional asymmetry tests for pelvic landmarks, the research team evaluates 40 adult volunteers.  For this stage, data is collected in a blinded manner, no consensus training occurs and data is processed after the 40 subjects have been evaluated.  Weighted kappa coefficients and 95% CIs have been used to determine reliability thresholds.