Perfect the Puff: Reinforcing Metered-dose Inhaler Excellence amongst Primary Care Trainees for Optimal Asthma Management

Background: There are key gaps regarding proper metered-dose inhaler (MDI) technique during Internal Medicine Residency training. Inhaler misuse remains common, underscoring the need for continued reinforcement. This study aims to assess the efficacy of one training session, which reviews the 8 steps for MDI use.

Methods: We recruited 30 Internal Medicine resident volunteers at an urban medical center with a high community prevalence of asthma to participate in a teaching session that included 8 core steps for proper MDI use. We administered a pre-survey asked about trainees’ prior teaching and how they currently teach and assess the MDI technique. Participants completed a post-intervention survey listing the MDI steps.

Results: Most were not previously taught the MDI technique (n=21), and whether one was previously taught the MDI technique did not differ by gender (p=0.94) nor class year (p>0.99). Of the participants who were previously taught the MDI technique (n=9), no participants were confident in assessing the technique (0%) nor providing a demonstration (0%), though most (67%) of these individuals felt they could verbally teach the MDI technique. Pre to post-survey findings demonstrated an average improvement of 3.6 to 6.6 MDI steps correctly identified (p< 0.01). The implications of these findings underscore the need to not only teach IM residents about the MDI technique but also ensure continuous reinforcement regardless of gender or level of training.

Conclusion: Reinforcing the MDI technique through a training session is an intervention to enhance IM residents’ knowledge. Future studies can assess the impact of longitudinal training through digital education tools and assess the retention of MDI technique knowledge. Recommendations for future training sessions could assess the impact of digital education as well as other modalities such as visual aids and hands-on training.