Article Text

  1. L. L. Willett,
  2. A. Castiglioni,
  3. F. S. Massie,
  4. G. R. Heudebert,
  5. C. A. Estrada,
  6. R. M. Centor
  1. Birmingham, AL.


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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