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Journal of General Internal Medicine

, Volume 25, Issue 8, pp 865–872 | Cite as

Narrative Review: Should Teaching of the Respiratory Physical Examination Be Restricted Only to Signs with Proven Reliability and Validity?

  • Jochanan BenbassatEmail author
  • Reuben Baumal
Reviews

Abstract

OBJECTIVE

To review the reported reliability (reproducibility, inter-examiner agreement) and validity (sensitivity, specificity and likelihood ratios) of respiratory physical examination (PE) signs, and suggest an approach to teaching these signs to medical students.

METHODS

Review of the literature. We searched Paper Chase between 1966 and June 2009 to identify and evaluate published studies on the diagnostic accuracy of respiratory PE signs.

RESULTS

Most studies have reported low to fair reliability and sensitivity values. However, some studies have found high specificites for selected PE signs. None of the studies that we reviewed adhered to all of the STARD criteria for reporting diagnostic accuracy.

CONCLUSIONS

Possible flaws in study designs may have led to underestimates of the observed diagnostic accuracy of respiratory PE signs. The reported poor reliabilities may have been due to differences in the PE skills of the participating examiners, while the sensitivities may have been confounded by variations in the severity of the diseases of the participating patients.

IMPLICATION FOR PRACTICE AND MEDICAL EDUCATION

Pending the results of properly controlled studies, the reported poor reliability and sensitivity of most respiratory PE signs do not necessarily detract from their clinical utility. Therefore, we believe that a meticulously performed respiratory PE, which aims to explore a diagnostic hypothesis, as opposed to a PE that aims to detect a disease in an asymptomatic person, remains a cornerstone of clinical practice. We propose teaching the respiratory PE signs according to their importance, beginning with signs of life-threatening conditions and those that have been reported to have a high specificity, and ending with signs that are "nice to know," but are no longer employed because of the availability of more easily performed tests.

KEY WORDS

respiratory physical examination diagnostic accuracy medical students 

Notes

Conflict of Interest

None disclosed.

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Copyright information

© Society of General Internal Medicine 2010

Authors and Affiliations

  1. 1.Myers-JDC-Brookdale InstituteSmokler Center for Health Policy ResearchJerusalemIsrael
  2. 2.Department of Laboratory Medicine and PathobiologyToronto Hospital for Sick Children and University of TorontoTorontoCanada

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