Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2024 Dec 5:11:23821205241303560.
doi: 10.1177/23821205241303560. eCollection 2024 Jan-Dec.

Practice and Evaluation of Competence in Assessment of Arterial Circulation of the Lower Limbs among Medical Students and Physicians in Training - A Systematic Review

Martin Macek  1 , Frida Eek  2 , Axel Wrede  1 , Talha Butt  1   3 , Stefan Acosta  1   3
Affiliations
Review

Practice and Evaluation of Competence in Assessment of Arterial Circulation of the Lower Limbs among Medical Students and Physicians in Training - A Systematic Review

Martin Macek et al. J Med Educ Curric Dev. .

Abstract

Introduction: A recent study on patients with acute lower limb ischemia showed that the proportion of inadequate examination of lower extremity circulation was associated with higher rate of amputation and death. The aim of this systematic review was to explore evidence for how practical competence in performing a peripheral vascular status of the lower limb among medical students and junior doctors should be taught and examined.

Methods: The systematic review followed PRISMA guidelines and was published in PROSPERO. Articles were searched for in PubMed, Cochrane Library and Embase. The result was processed by two researchers. After title- and abstract screenings, articles were scrutinized in full text for inclusion, result extraction, risk of bias assessment through Medical Education Research Study Quality Instrument (MERSQI), and evidence grading with the GRADE approach.

Results: Thirteen studies were included. Two studies were randomized controlled trials (RCTs). Study samples varied between medical students (n = 9), junior doctors (n = 3) and residents (n = 3). Interventions varied between theoretical, practical, repetitive training, feedback-based learning, and clinical experience. Assessed measurements (outcomes) were ankle-brachial index (ABI) (n = 9), theoretical knowledge (n = 4), pulse palpation (n = 1) and complete vascular status (n = 1). Experienced residents had better theoretical knowledge than inexperienced residents, but performance of the entire ABI procedure without any mistake according to guidelines was inadequate in both groups. One RCT showed that experimental training significantly increased ability to perform ABI measurements, but this ability decreased after six months without repetition.

Conclusion: Theoretical training alone is not sufficient in ensuring proficiency in vascular examination of the lower limbs. Continuous practice and clinical exposure are crucial to maintain proficiency in performing vascular examination of the lower limbs. Data is limited and heterogenous. The level of certainty for the evidence was judged to be very low.

Keywords: Vascular examination; clinical practice; lower extremity arterial disease; lower extremity circulation; medical education.

PubMed Disclaimer

Conflict of interest statement

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
PRISMA table of literature review.
See this image and copyright information in PMC

Similar articles

See all similar articles

References

    1. Fowkes FG, Rudan D, Rudan I, et al. Comparison of global estimates of prevalence and risk factors for peripheral artery disease in 2000 and 2010: a systematic review and analysis. Lancet. Oct 19 2013;382(9901):1329‐1340. doi:10.1016/s0140-6736(13)61249-0 - DOI - PubMed
    1. Sigvant B, Wiberg-Hedman K, Bergqvist D, et al. A population-based study of peripheral arterial disease prevalence with special focus on critical limb ischemia and sex differences. J Vasc Surg. Jun 2007;45(6):1185‐1191. doi:10.1016/j.jvs.2007.02.004 - DOI - PubMed
    1. Bjorck M, Earnshaw JJ, Acosta S, et al. Editor's choice - European society for vascular surgery (ESVS) 2020 clinical practice guidelines on the management of acute limb ischaemia. Eur J Vasc Endovasc Surg. Feb 2020;59(2):173‐218. doi:10.1016/j.ejvs.2019.09.006 - DOI - PubMed
    1. Firnhaber JM, Powell CS. Lower extremity peripheral artery disease: diagnosis and treatment. Am Fam Physician. Mar 15 2019;99(6):362‐369. - PubMed
    1. Aboyans V, Ricco JB, Bartelink MEL, et al. 2017 ESC guidelines on the diagnosis and treatment of peripheral arterial diseases, in collaboration with the European society for vascular surgery (ESVS): document covering atherosclerotic disease of extracranial carotid and vertebral, mesenteric, renal, upper and lower extremity arteriesEndorsed by: the European stroke organization (ESO)The task force for the diagnosis and treatment of peripheral arterial diseases of the European Society of Cardiology (ESC) and of the European society for vascular surgery (ESVS). Eur Heart J. Mar 1 2018;39(9):763‐816. doi:10.1093/eurheartj/ehx095 - DOI - PubMed

LinkOut - more resources