Abstract
Background
: The purpose of this research was to use direct observation of the physical examination
to elucidate the role physical examination technique plays in diagnostic accuracy.
Physical examination is important for quality clinical care and requires multiple
interrelated skills. The relationship of physical examination technique to related
skills is poorly understood. Current methods of teaching and assessing physical examination
skills provide few opportunities to evaluate physical examination technique and accuracy.
Methods
: The authors developed a clinical examination assessment using volunteer patients
and direct observation. Trained faculty preceptors rated resident performance in 7
domains: 1) physical examination technique, 2) identification of physical signs, 3)
clinical communication, 4) differential diagnosis, 5) clinical judgment, 6) managing
patient concerns, and 7) maintaining patient welfare. The Pearson correlation coefficient
was used to determine relationships between performance in each of these domains.
Data on residents’ self-assessed competency in the physical examination and perceptions
of feedback received during the assessment were collected.
Results
: From December 2018 to February 2020, 113 interns from 2 internal medicine residency
programs participated in the assessment. Physical examination technique was significantly
correlated with accurate identification of physical signs, differential diagnosis
and clinical judgment. Time spent in graduate medical education was negatively correlated
with performance. Interns more highly rated the feedback received from this assessment
than traditional clinical skills feedback.
Conclusions
: Our findings emphasize the necessity of multi-dimensional physical examination assessment.
Observed deterioration of physical examination skill during internship may reflect
contemporary practice patterns, which deprioritize the physical examination. Future
research on physical examination education should focus on the interface between physical
examination technique and related clinical skills.
Keywords
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Article Info
Publication History
Published online: December 30, 2021
Footnotes
Funding: This work was funded by the Johns Hopkins Institute for Excellence in Education Berkheimer Faculty Scholars Award, the New York Academy of Medicine Jeremiah A. Barondess Fellowship in the Clinical Transaction (in collaboration with the Accreditation Council for Graduate Medical Education), Funder Id: http://dx.doi.org/10.13039/100007261, the American Board of Medical Specialties Visiting Scholar Program (with support from the Gordon and Betty Moore Foundation), and the American Medical Association Reimagining Residency Initiative. The content does not purport to reflect the views of the American Medical Association or any member of the Accelerating Change in Medical Education Consortium. The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.
Conflict of Interest: BTG and TN are board members of the Society of Bedside Medicine.
Authorship: All authors had access to the data and a role in writing this manuscript.
Identification
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