Purpose To determine whether a structured physical examination course improved physical examination skills for residents during an inpatient ward experience.
Methods We developed a bedside physical diagnosis course of pulmonary, cardiovascular, abdomen, and musculoskeletal system sessions. Postgraduate year (PGY)-1 residents on inpatient ward services were assigned to receive the sessions (n = 8) or not (n = 8) over a one month time period. We measured pre and post performance with a five-station objective structured clinical examination (OSCE) testing cases of pneumonia, shoulder pain, ascites, congestive heart failure (CHF), and back pain. Standardized patients scored performance with task specific checklists (range: 0-100%). Eight departing PGY-3 residents (n = 8) also participated in the OSCE evaluation for purposes of comparison. We used nonparametric analysis to compare groups.
Results Both groups of PGY-1 residents (n = 16) had a trend for improved overall performance following one month of ward experience (median change 66% to 81%, p = .67). Median changes in performance were seen across each station (pneumonia +23%, shoulder pain +14%, ascites +16%, CHF +9%, and back +3%, all p > .05). PGY-1 residents participating in the physical diagnosis course did not show a statistical improvement compared to the control group. The overall PGY-1 post OSCE median performance was similar to the departing PGY-3 resident performance (pneumonia 77% vs 65%, shoulder pain 71% vs 68%, ascites 85% vs 85%, CHF 82% vs 82%, back pain 78% vs 84%, overall 81% vs 76%, all p > .05).
Conclusions Our pilot study suggests that regardless of participation in a structured physical diagnosis curriculum, exposure to one month of an inpatient ward experience improved the physical examination skills of PGY-1 residents. Performance improved most in cases likely encountered in a hospitalized patient, such as pneumonia and ascites. The performance of our PGY-1 residents after only one month of wards approached or exceeded the departing PGY-3 performance. This early peak in performance suggests an advanced physical diagnosis curriculum may have greater effect if targeted to more senior residents.
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