Advances in Health Sciences Education

, Volume 14, Issue 4, pp 547–556 | Cite as

Development, impact, and measurement of enhanced physical diagnosis skills

  • Miriam A. Smith
  • William B. Burton
  • Meggan Mackay
Original Paper

Abstract

Evidence suggests that the quality and frequency of bedside clinical examination have declined. We undertook the study to (1) determine whether intensive instruction in physical examination enhances medical student skills and (2) develop a tool to evaluate those skills using a modified observed structured clinical examination (OSCE). This was a randomized, blinded, prospective, year-long study involving 3rd year students at the Albert Einstein College of Medicine. Students were randomized to receive intensive instruction in physical examination [study group (n = 46)] or usual instruction [control group (n = 75)] and evaluated by a modified OSCE. The OSCE consisted of 6 real patient stations: Head, ears, eyes, neck, throat; pulmonary; cardiovascular; gastrointestinal; neurology; musculoskeletal; and 2 computer imaging stations: genitourinary and dermatology. A faculty member present at each patient station evaluated student performance. Data were analyzed using t-tests for comparison of the mean scores between the two groups for each station and for average scores across stations. A total of 121 students were tested. The study group performed significantly better than the control group in the gastrointestinal station (p = 0.0004), the combined average score across the six real patient stations (p = 0.0001), and the combined average score across all eight stations (p = 0.0014). Intensive physical diagnosis instruction enhances physical examination skills of 3rd year medical students. The modified OSCE is a useful tool to evaluate these skills.

Keywords

Physical diagnosis skills measurement Modified OSCE 

References

  1. Anderson, R. C., Fagan, M. J., & Sebastian, J. (2001). Teaching students the art and science of physical diagnosis. The American Journal of Medicine, 110, 419–423. doi:10.1016/S0002-9343(01)00621-0.CrossRefGoogle Scholar
  2. Carraccio, C., & Englander, R. (2000). The objective structured clinical examination: a step in the direction of competency-based evaluation. Archives of Pediatrics & Adolescent Medicine, 154, 736–741.Google Scholar
  3. Corbett, E. C., Jr, Payne, N. J., Bradley, E. B., Maughan, K. L., Heald, E. B., & Wang, X. Q. (2007). Enhancing clinical skills education: University of Virginia School of Medicine’s Clerkship Clinical Skills Workshop Program. Academic Medicine, 82, 690–695. doi:10.1097/ACM.0b013e31806745b4.CrossRefGoogle Scholar
  4. Doig, C. J., Harasym, P. H., Fick, G. H., & Baumber, J. S. (2000). An objective look at OSCES: The effects of examiner background, station organization, and time of examination on OSCE scores assessing undergraduate medical students’ physical examination skills. Academic Medicine, 75(10), S96–S98.Google Scholar
  5. Fagan, M. J., Griffith, R. A., Obbard, L., & O’Connor, C. J. (2003). Improving the physical diagnosis skills of third-year medical students: a controlled trial of a literature-based curriculum. Journal of General Internal Medicine, 18, 652–655. doi:10.1046/j.1525-1497.2003.20821.x.CrossRefGoogle Scholar
  6. Fox, R., Dacre, J., & McLure, C. (2001). The impact of formal instruction in clinical examination skills on medical student performance—the example of peripheral nervous system examination. Medical Education, 35, 371–373. doi:10.1046/j.1365-2923.2001.00732.x.CrossRefGoogle Scholar
  7. Gale, C. P., & Gale, R. P. (2006). Is bedside teaching in cardiology necessary for the undergraduate education of medical students? Medical Education, 40, 11–13. doi:10.1111/j.1365-2929.2005.02357.x.CrossRefGoogle Scholar
  8. Harden, R. M., Stevenson, M., Downie, W. W., & Wilson, G. M. (1975). Assessment of clinical competence using an objective structured examination. British Medical Journal, 1, 447–451.CrossRefGoogle Scholar
  9. Holmboe, E. S., Hawkins, R. E., & Huot, S. J. (2004). Effects of training in direct observation of medical residents’ clinical competence. Annals of Internal Medicine, 140, 874–881.Google Scholar
  10. Jain, S. S., DeLisa, J. A., Nadler, S., Kirshblum, S., et al. (2000). One program’s experience of OSCE vs. written board certification results: a pilot study. American Journal of Physical Medicine & Rehabilitation, 79, 462–467. doi:10.1097/00002060-200009000-00012.CrossRefGoogle Scholar
  11. Jain, S. S., Nadler, S., Eyles, M., Kirshblum, S., et al. (1997). Development of an objective structured clinical examination (OSCE) for physical medicine and rehabilitation residents. American Journal of Physical Medicine & Rehabilitation, 76, 102–106. doi:10.1097/00002060-199703000-00003.CrossRefGoogle Scholar
  12. Junger, J., Schafer, S., Roth, C., Schelberg, D., Friedman Ben-David, M., & Nikendei, C. (2005). Effects of basic clinical skills training on objective structured clinical examination performance. Medical Education, 39, 1015–1020. doi:10.1111/j.1365-2929.2005.02266.x.CrossRefGoogle Scholar
  13. LaCombe, M. A. (1997). On bedside teaching. Annals of Internal Medicine, 126, 217–220.Google Scholar
  14. Lehmann, L. S., Brancati, F. L., Chen, M. C., Roter, D., & Dobs, A. S. (1997). The effect of bedside case presentations on patients’ perceptions of their medical care. The New England Journal of Medicine, 336, 1150–1155. doi:10.1056/NEJM199704173361606.CrossRefGoogle Scholar
  15. Mangione, S., & Nieman, L. Z. (1997). Cardiac auscultatory skills of internal medicine and family practice trainees. A comparison of diagnostic proficiency. Journal of the American Medical Association, 278, 717–722. doi:10.1001/jama.278.9.717.CrossRefGoogle Scholar
  16. Mangione, S., & Peitzman, S. J. (1996). Physical diagnosis in the l990’s: art or artifact? Journal of General Internal Medicine, 11, 490–493. doi:10.1007/BF02599046.CrossRefGoogle Scholar
  17. McMahon, G. T., Marina, O., Kritek, P. A., & Katz, J. T. (2005). Effect of a physical examination teaching program on the behavior of medical residents. Journal of General Internal Medicine, 20, 710–714. doi:10.1111/j.1525-1497.2005.0159.x.CrossRefGoogle Scholar
  18. Nair, B. R., Coughlan, J. L., & Hensley, M. J. (1997). Student and patient perspectives on bedside teaching. Medical Education, 31, 341–346. doi:10.1046/j.1365-2923.1997.00673.x.CrossRefGoogle Scholar
  19. Paauw, D. S., Wenrich, M. D., Curtis, R., Carline, J. D., & Ramsey, P. G. (1995). Ability of primary care physicians to recognize physical findings associated with HIV infection. Journal of the American Medical Association, 274, 1380–1382. doi:10.1001/jama.274.17.1380.CrossRefGoogle Scholar
  20. Peterson, M. C., Holbrook, J. H., Von Hales, D., Smith, N. L., & Staker, L. V. (1992). Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses. The Western Journal of Medicine, 156, 163–165.Google Scholar
  21. Reilly, B. M. (2003). Physical examination in the care of medical inpatients: an observational study. Lancet, 362, 1100–1105. doi:10.1016/S0140-6736(03)14464-9.CrossRefGoogle Scholar
  22. Sackett, D. L., & Rennie, D. (1992). The science of the art of the clinical examination. Journal of the American Medical Association, 267, 2650–2652. doi:10.1001/jama.267.19.2650.CrossRefGoogle Scholar
  23. Schwind, C. J., Boehler, M. L., Folse, R., Dunnington, G., & Markwell, S. J. (2001). Development of physical examination skills in a third-year surgical clerkship. American Journal of Surgery, 181, 338–340. doi:10.1016/S0002-9610(01)00573-6.CrossRefGoogle Scholar
  24. Smith, M. A., Gertler, T., & Freeman, K. (2003). Medical students’ perceptions of their housestaffs’ ability to teach physical examination skills. Academic Medicine, 78, 80–83.CrossRefGoogle Scholar
  25. Townsend, A. H., McIlvenny, S., Miller, C. J., & Dunn, E. V. (2001). The use of an objective structured clinical examination (OSCE) for formative and summative assessment in a general practice clinical attachment and its relationship to final medical school examination performance. Medical Education, 35, 841–846. doi:10.1046/j.1365-2923.2001.00957.x.CrossRefGoogle Scholar
  26. Wilkerson, L., & Lee, M. (2003). Assessing physical examination skills of senior medical students: knowing how vs. knowing when. Academic Medicine, 78, S30–S32. doi:10.1097/00001888-200310001-00010.CrossRefGoogle Scholar
  27. York, N. L., Niehaus, A. H., Markwell, S. J., & Folse, J. R. (1999). Evaluation of students’ physical examination skills during their surgery clerkship. American Journal of Surgery, 177, 240–243. doi:10.1016/S0002-9610(99)00005-7.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media B.V. 2008

Authors and Affiliations

  • Miriam A. Smith
    • 1
  • William B. Burton
    • 2
  • Meggan Mackay
    • 3
    • 4
  1. 1.Division of Infectious Disease—Staff house rm. 226Long Island Jewish Medical Center, Long Island Campus for the Albert Einstein College of MedicineNew Hyde ParkUSA
  2. 2.Office of Educational ResourcesAlbert Einstein College of MedicineBronxUSA
  3. 3.Jacobi Medical CenterBronxUSA
  4. 4.Autoimmune Disease CenterFeinstein Research InstituteManhassetUSA

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