The examination of the jugular venous pressure (JVP): variation of technique amongst Nigerian resident doctors.

Resident doctors in Internal Medicine Faculty and General Medical Practice from accredited residency programmes from all over Nigeria were surveyed to investigate the existence of variation in the technique of clinical examination. Using a 10 item self administered questionnaire, the doctors were required to answer questions to test knowledge and skill of examining the jugular venous pressure. Data from 70 Internal Medicine (IMR) and 30 General Medical Practice Residents (GMP) were analysed. For both groups, years of post medical graduation and period spent in residency programme were comparable. On methodology of examination of JVP, there was significant inter- and intra group variation. Sixty per cent (60%) of IMR and only 10% of family practice doctors will use the internal jugular vein alone for assessment, whilst a comparable proportion (30% of IMR and 25% of GMP) will use both internal and external jugular veins. Whilst the sternal angle was the choice of reference point in the majority (87% of IMR versus 80% of GMP), the patient placement angle of 45 degrees was 93% for IMR and 100% for GMP. No respondent chose 60 degrees. Only 40% of both IMR and GMP will always use confirmatory maneuvers, especially the hepatojugular reflux. No GMP doctor and 25% of internal medicine will sometimes use posture and respiratory maneuvers to enhance their clinical decisions. Only 33% IMR and 40% of GMP indicated a correct value and/or unit of measurement for normal jugular venous pressure (JVP). Comparing the internal medicine and General Medical Practice Residents, there was marked inter- and intra-group variation, with more variation noted amongst the IMR. Most importantly, less than 50% of residents knew the correct value of an abnormal JVP. This variability of methodology and poor knowledge will impact on performance in the residency programme, patient care and medical education.