Seventy-one individuals completed the questionnaire for the initial audit and 46 in the follow-up audit (Table 1). It was registered at the research offices for all three DHBs. The audit was deemed to be outside the scope of review by the Health and Disability Ethics Committee, New Zealand. Unanswered questions were marked as being incorrect. The Holm-Bonferroni method was applied to the Part 2 results adjusted for multiple comparisons. Statistical analysis was completed using IBM SPSS Statistics version 23 for Windows and Fisher’s exact test to determine statistical significance for discrete variables. Part 2 of the questionnaire remained unchanged. The teaching covered all questions in the MoCA and the formal administration and scoring guidelines corresponding to each question (available at Part 1 of the repeat questionnaire was the same as the initial audit with the addition of two questions whether participants had completed the initial questionnaire and whether they felt teaching was beneficial or not (Appendix 3). Several weeks after the initial questionnaire a 15-minute teaching session was given followed immediately by a repeat of the questionnaire. Results were assessed using a marking scheme and verified by two separate study investigators (Appendix 2). They were given a copy of a blank MoCA test sheet but not the official administration or marking schedule. Part 2 consisted of examples of completed questions from the MoCA designed to test participants’ ability to identify errors in administration and score the test. Part 1 comprised of participant demographics and information regarding the frequency of MoCA administration, prior knowledge about the test and experience of formal teaching. Participants completed an anonymous two-part written questionnaire (Appendix 1). Participants included first-year doctors (also known as house officers) and final-year medical students (trainee interns) attending protected training time sessions. This audit was completed between April and June 2017 at Canterbury, Capital and Coast and Hutt Valley District Health Boards (DHBs) in New Zealand. We hypothesised that formal teaching would improve the results on a follow-up audit. We therefore designed an audit with the aim of investigating junior doctors’ knowledge of how to complete the MoCA. No studies assessing accuracy of MoCA administration and scoring were identified through a literature search. This led to concerns that there could be errors in administration and scoring, which could impact on patient clinical outcomes. Knowledge on how to administer and score the MoCA seemed to be variable among junior doctors. There is also a blind version and more recently an application (app) for smart devices.11Īnecdotally, we noted that completing the MoCA test was often a task given to the most junior members of inpatient medical teams. The MoCA test comprises 30 questions assessing various domains of cognition and can be performed in 10 minutes.1 Formal instructions on how to administer the test and score the results are easily accessible on the official website ( It is used in over 100 countries and is available in 46 languages and dialects. The MoCA has been shown to be superior for the detection of mild cognitive impairment compared to the MMSE in many other studies since,2,3,4 and is a useful tool for predicting the development of dementia in patients with mild cognitive impairment.5 It also has a role in cognitive assessment in a wide range of other conditions, including Parkinson’s disease,6,7 chronic obstructive pulmonary disease,8 transient ischaemic attack and minor stroke,9 and Huntington’s disease.10 In the original validation study the MoCA was shown to have a sensitivity of 90% and specificity of 87% for the detection of mild cognitive impairment, compared to 18% and 100% for the MMSE.1 The Montreal Cognitive Assessment (MoCA) was developed in 2005 to detect individuals with mild cognitive complaints who performed within the normal range on the Mini Mental State Exam (MMSE).1 Mild cognitive impairment is a state between the normal cognitive changes associated with aging and dementia.
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