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Physical Examination Skills Among Chief Residents in Psychiatry: Practices, Attitudes, and Self-Perceived Knowledge

Abstract

Objectives

The authors investigated the attitudes, self-perceived competence, and the need for a dedicated curriculum on physical examination skills among chief residents in psychiatry.

Methods

A voluntary 28-item web-based questionnaire was distributed to psychiatry chief residents in the USA between January 2019 and February 2019.

Results

Of 181 chief residents, 79 (response rate, 44%) completed the online survey. The majority of chief residents want to improve their physical exam skills (64%) and believe that there should be a targeted curriculum aimed at incorporating these skills into everyday psychiatric practice (63%). However, most (57%) chief residents reported that they only conduct physical exams on a few selected patients (< 25% of the time) and almost half (48%) last used a stethoscope a year ago, if not longer. Self-perceived competence and comfort level with neurology-related exam findings was especially low: only 35% could identify discrepant neurological findings and 33% elicit Hoover’s sign of leg paresis. A significant majority (86%) believed that performing a physical exam would not interfere with the therapeutic relationship.

Conclusions

Although chief residents in psychiatry believe that developing competence in physical examinations is important to their education, the current educational landscape does not support the development of these skills. Future educational strategies should focus on addressing this need.

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References

  1. 1.

    Menninger KA. A manual for psychiatric case study. 2d ed. New York: Grune & Stratton; 1962. p. 48–9.

  2. 2.

    Murray J, Baillon S, Bruce J, Velayudhan L. A survey of psychiatrists’ attitudes towards the physical examination. J Ment Health. 2015;24(4):249–54.

  3. 3.

    McIntyre JS, Romano J. Is there a stethoscope in the house (and is it used)? Arch Gen Psychiatry. 1977;34(10):1147–51.

  4. 4.

    Krummel S, Kathol RG. What you should know about physical evaluations in psychiatric patients: results of a survey. Gen Hosp Psychiatry. 1987;9(4):275–9.

  5. 5.

    Hodgson R, Adeyemo O. Physical examination performed by psychiatrists. Int J Psychiatry Clin Pract. 2004;8(1):57–60.

  6. 6.

    Murray J, Baillon S. Case series of physical examinations on psychiatric inpatients: influence of a structured form on the quality of documentation. J Ment Health. 2013;22(5):428–38.

  7. 7.

    Rigby JC, Oswald AG. An evaluation of the performing and recording of physical examinations by psychiatric trainees. Br J Psychiatry. 1987;150(04):533–5.

  8. 8.

    Vanezis AP, Manns D. Physical examinations of mental health service users. Prog Neurol Psychiatry. 2010;14(4):19–23.

  9. 9.

    Koranyi EK. Undiagnosed physical illness in psychiatric patients. Annu Rev Med. 1982;33(1):309–16.

  10. 10.

    Hall RCW. Physical illness presenting as psychiatric disease. Arch Gen Psychiatry. 1978;35(11):1315.

  11. 11.

    Hert MD, Correll CU, Bobes J, Cetkovich-Bakmas M, Cohen D, Asai I, et al. Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World Psychiatry. 2011;10(1):52–77.

  12. 12.

    Phelan M, Stradins L, Morrison S. Physical health of people with severe mental illness. BMJ. 2001;322(7284):443–4.

  13. 13.

    Hert MD, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, et al. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry. 2011;10(2):138–51.

  14. 14.

    Mangurian C, Newcomer JW, Modlin C, Schillinger D. Diabetes and cardiovascular care among people with severe mental illness: a literature review. J Gen Intern Med. 2016;31(9):1083–91.

  15. 15.

    Norton J. The importance of the physical examination in a psychiatry residency program. Acad Psychiatry. 2001;25(4):236–7.

  16. 16.

    Azzam PN, Gopalan P, Brown JR, Aquino PR. Physical examination for the academic psychiatrist: primer and common clinical scenarios. Acad Psychiatry. 2016;40(2):321–7.

  17. 17.

    Madan R, Conn D, Dubo E, Voore P, Wiesenfeld L. The enablers and barriers to the use of direct observation of trainee clinical skills by supervising faculty in a psychiatry residency program. Can J Psychiatry. 2012;57(4):269–72.

  18. 18.

    The Psychiatry Milestones Project. A joint initiative of the Accreditation Council for Graduate Medical Education and the American Board of Psychiatry and Neurology [Internet]. [cited 2018 Sep 19]. Available from: http://acgme.org/acgmeweb/Portals/0/PDFs/Milestones/PsychiatryMilestones.pdf

  19. 19.

    Van L, Boot E, Bassett AS. Update on the 22q11.2 deletion syndrome and its relevance to schizophrenia. Curr Opin Psychiatry. 2017;30(3):191–6.

  20. 20.

    Koranyi EK, Potoczny WM. Physical illnesses underlying psychiatric symptoms. Psychother Psychosom. 1992;58(3–4):155–60.

  21. 21.

    Liberman R. Advisability of therapists conducting physical exams. Am J Psychiatry. 1968;124(10):1467-a.

  22. 22.

    Kick SD, Morrison M, Kathol RG. Medical training in psychiatry residency. A proposed curriculum. Gen Hosp Psychiatry. 1997;19(4):259–66.

  23. 23.

    The American Psychiatric Association Practice Guidelines for the Psychiatric Evaluation of Adults [Internet]. Third Edition. American Psychiatric Association; 2015 [cited 2019 May 5]. Available from: http://psychiatryonline.org/doi/book/10.1176/appi.books.9780890426760

  24. 24.

    Ovsiew F, Lovinger D. General medical evaluation and management of the psychiatric inpatient. In: Ovsiew F, Munich RL, editors. Principles of Inpatient Psychiatry. Philadelphia: Lippincott Williams & Wilkins; 2008. p. 71–96.

  25. 25.

    Summers WK, Munoz RA, Read MR. The psychiatric physical examination - Part I: methodology. J Clin Psychiatry. 1981;42(3):95–8.

  26. 26.

    Garden G. Physical examination in psychiatric practice. Adv Psychiatr Treat. 2005;11(2):142–9.

  27. 27.

    Willett LL, Estrada CA, Castiglioni A, Massie FS, Heudebert GR, Jennings MS, et al. Does residency training improve performance of physical examination skills? Am J Med Sci. 2007;333(2):74–7.

  28. 28.

    Schiller J, Hammoud M, Belmonte D, Englesbe M, Gelb D, Grum C, et al. Systematic direct observation of clinical skills in the clinical year. MedEdPORTAL [Internet]. 2014 [cited 2019 May 24];(10). Available from: https://www.mededportal.org/publication/9712/

  29. 29.

    Madva E, Cooper JJ. Functional neurological disorder [Internet]. 2018 [cited 2019 Aug 27]. Available from: https://www.nncionline.org/course/functional-neurological-disorder/

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Acknowledgments

The authors would like to thank the University of Chicago MERITS (Medical Education, Research, Innovation, Teaching and Scholarship) program for its support and guidance.

Author information

Correspondence to Michel Medina.

Ethics declarations

This study was approved for exempt status by the IRB of the University of Chicago (IRB 18-0744).

Disclosure

On behalf of all authors, the corresponding author states that there is no conflict of interest.

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Medina, M., Garza, D.M. & Cooper, J.J. Physical Examination Skills Among Chief Residents in Psychiatry: Practices, Attitudes, and Self-Perceived Knowledge. Acad Psychiatry 44, 68–72 (2020). https://doi.org/10.1007/s40596-019-01124-9

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Keywords

  • Physical examination
  • Psychiatry
  • Residency
  • Medical education
  • Clinical skills
  • Bedside exam