Teaching and Evaluating Residents' Epinephrine Autoinjector Use with the Epipen® Proficiency Assessment Tool (E-PAT)

Rationale: Physicians, regardless of training level, under-diagnose and under-manage anaphylaxis, a potentially life-threating allergic reaction. Epinephrine is the first-line anaphylaxis treatment, but data on provider proficiency using epinephrine autoinjectors are limited. Teaching resident physicians how to use epinephrine autoinjectors is a modifiable deficiency. 

Methods: We designed a 15-minute educational module including: viewing manufacturer instructional video excerpt, practicing hands-on with colleagues, and receiving feedback from an allergist. To assess EpiPen® proficiency, we developed a checklist of 8 critical actions for EpiPen® administration called E-PAT (EpiPen® Proficiency Assessment Tool). We validated E-PAT in two distinct groups: internal medicine interns during orientation, and radiology residents (PGY 2-5). Two independent raters used E-PAT to evaluate resident proficiency: an allergist and a trained senior resident evaluated medicine residents, whereas an allergist and a person without medical training evaluated radiology residents. Inter-rater reliability and mean E-PAT scores (maximum = 8) were calculated.

Results: Participants included 58 medicine interns and 37 radiology residents. Both groups demonstrated excellent proficiency immediately after the training: Internal medicine interns (mean = 7.52 ± 0.85) and radiology residents (mean = 7.55 ± 0.66). There was good inter-rater agreement between two physicians (Cohen’s Kappa = 0.78 ± 0.23) and between a physician and lay person (Cohen’s Kappa = 0.89 ± 0.23).

Conclusions: Residents achieve proficiency in EpiPen® usage by participating in a brief, multimodal educational program. E-PAT is a validated, simple-to-use tool for assessing clinician EpiPen® proficiency. High inter-rater reliability between physician and lay person suggests that a trained lay person can evaluate residents.