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Alharbi LA, Cheikh M, Alotaibi ME, Alkhotani AA, Alim HM, Almalki F, Samannodi MS, Khadawardi HA, Imam AA, Turkistani YA, Bashal FB, Tawakul A, Bulkhi AA, Dairi MS, Zaini R, Almoallim HM. Developing and Validating Entrustable Professional Activities (EPAs) for Rheumatology Fellowship Training Programs in Saudi Arabia: A Delphi Study. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2024; 15:845-856. [PMID: 39308482 PMCID: PMC11416783 DOI: 10.2147/amep.s481977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/24/2024] [Accepted: 09/13/2024] [Indexed: 09/25/2024]
Abstract
Background Entrustable professional activities (EPAs) define the core tasks that a graduating rheumatologist needs to perform independently in practice. The objective of this study was to develop and validate EPAs for rheumatology fellowship training programs in Saudi Arabia. Methods Experts met to develop an initial set of potential end-of-training EPAs by conducting a comprehensive literature review of EPAs and studying the Saudi rheumatology fellowship curriculum. Then, to validate the EPAs, we conducted two rounds of the modified Delphi technique among rheumatology experts in Saudi Arabia. A response rate of 80% was considered and the minimum number of experts needed to be 25 to 30. Descriptive statistics were utilized to describe participants' demographic characteristics and group responses to each statement in all rounds. The experts were asked to rate the relevancy of each EPA using a 5-point Likert scale in both Delphi rounds. Results In the preliminary phase, four rheumatologists developed an initial set of 36 core EPAs for rheumatology training program in Saudi Arabia. For the two-rounds Delphi techniques, 32 experts were invited to complete the study. The response rate of the first and second round were, 78.12% (25) and 93.75% (30), respectively. The first-round Delphi resulted in a robust consensus on 31 EPAs for rheumatology training. Five EPAs were excluded, and one new EPA was proposed. In the subsequent round, all 32 EPAs achieved strong consensus. The eliminated EPAs likely fell short in one or more of the following areas: relevance to rheumatology practice in Saudi Arabia, overlapping with other EPAs, or practical challenges in the implementation. Conclusion We have developed and validated a core set of EPAs for rheumatology fellowship training programs in Saudi Arabia. Mapping and identifying milestones for these EPAs are essential steps to follow to enhance workplace curriculum development.
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Affiliation(s)
- Laila A Alharbi
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Mohamed Cheikh
- Department of Medicine, Al Salama Hospital, Jeddah, Saudi Arabia
| | - Manal E Alotaibi
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Amal A Alkhotani
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Hussam M Alim
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Fahd Almalki
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | | | | | - Ahmad A Imam
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Yosra A Turkistani
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Fozya B Bashal
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Abdullah Tawakul
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Adeeb A Bulkhi
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Mohammad S Dairi
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Rania Zaini
- Department of Community Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
| | - Hani M Almoallim
- Department of Medicine, Umm Al-Qura University (UQU), Makkah, Saudi Arabia
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Karkache W, Halman S, Tran C, Nie R, Pugh D. Designing a touchless physical examination for a virtual Objective Structured Clinical Examination. CANADIAN MEDICAL EDUCATION JOURNAL 2024; 15:34-38. [PMID: 38827904 PMCID: PMC11139800 DOI: 10.36834/cmej.74261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2024]
Abstract
Purpose Given the COVID-19 pandemic, many Objective Structured Clinical Examinations (OSCEs) have been adapted to virtual formats without addressing whether physical examination maneuvers can or should be assessed virtually. In response, we developed a novel touchless physical examination station for a virtual OSCE and gathered validity evidence for its use. Methods We used a touchless physical examination OSCE station pilot-tested in a virtual OSCE in which Internal Medicine residents had to verbalize their approach to the physical examination, interpret images and videos of findings provided upon request, and make a diagnosis. We explored differences in performance by training year using ANOVA. In addition, we analyzed data using elements of Bloom's taxonomy of learning, i.e. knowledge, understanding, and synthesis. Results Sixty-seven residents (PGY1-3) participated in the OSCE. Scores on the pilot station were significantly different between training levels (F=3.936, p = 0.024, ηp2 = 0.11). The pilot station-total correlation (STC) was r = 0.558, and the item-station correlations ranged from r = 0.115-0.571, with the most discriminating items being those that assessed application of knowledge (interpretation and synthesis) rather than recall. Conclusion This touchless physical examination station was feasible, had acceptable psychometric characteristics, and discriminated between residents at different levels of training.
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Affiliation(s)
- Wassim Karkache
- Faculty of Medicine, The University of Ottawa, Ontario, Canada
| | - Samantha Halman
- Faculty of Medicine, The University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ontario, Canada
| | - Christopher Tran
- Faculty of Medicine, The University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ontario, Canada
| | - Rui Nie
- Medical Council of Canada, Ontario, Canada
| | - Debra Pugh
- Faculty of Medicine, The University of Ottawa, Ontario, Canada
- Department of Medicine, The Ottawa Hospital, Ontario, Canada
- Medical Council of Canada, Ontario, Canada
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Marshall H, Weingartner LA, Henry T, Smith J, Wright T, Bohnert CA, Shaw MA, Adamson DT. Assessing Abdominal Examination Skills in a Surgery Clerkship Standardized Patient Encounter for Curriculum Improvement. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2024; 11:23821205241272382. [PMID: 39119065 PMCID: PMC11307356 DOI: 10.1177/23821205241272382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2024] [Accepted: 07/18/2024] [Indexed: 08/10/2024]
Abstract
INTRODUCTION Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum. METHODS We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups. RESULTS In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely. CONCLUSIONS This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.
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Affiliation(s)
- Hannah Marshall
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Laura A. Weingartner
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Taylen Henry
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Jensen Smith
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Tiffany Wright
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
| | - Carrie A. Bohnert
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - M. Ann Shaw
- Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA
| | - Dylan T. Adamson
- Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA
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Azoyan L, Lombardi Y, Renaud MC, Duguet A, Georgin-Lavialle S, Cohen-Aubart F, Ibanez G, Steichen O. [Association between students' clinical performance and their success in the computerized national ranking tests: A single-center retrospective cohort study]. Rev Med Interne 2023; 44:5-11. [PMID: 35934597 DOI: 10.1016/j.revmed.2022.07.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2022] [Accepted: 07/04/2022] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Before attending residency, 6th-year French medical students must validate a final examination including a practical clinical test in their faculty. However, the national ranking that determines their future specialty and region solely relies on a computerized knowledge test. Our goal was to investigate the association between the final faculty test and the national ranking test. METHODS In our faculty, the final examination includes a computerized theoretical test (similar to the national one) and a practical test: a standardized evaluation of semiology skills at the bedside and a standardized assessment of relational skills with role plays. The agreements between the national test and faculty computerized and practical tests were analyzed by intraclass correlation coefficients (ICC). RESULTS Data from 1806 students who underwent the three examinations from 2017 to 2021 were analyzed. There was a good agreement between the ranks in the faculty and national computerized tests: ICC 0.83 (95% CI 0.81-0.85). By contrast, the agreement between the ranks in the faculty practical test and the national computerized test was poor: ICC 0.13 (95% CI 0.08-0.17). Results were stable over the years. CONCLUSION The agreement between the ranking of the current national test and the clinical skills assessed by a specific faculty test is poor. This could relate to a true independence or to different levels of motivation to perform well. Indeed, the result of the national test is the most important one as it determines their career. Incorporating a clinical assessment into the national ranking test will motivate students to acquire clinical skills and value those who perform well this practical dimension.
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Affiliation(s)
- L Azoyan
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France.
| | - Y Lombardi
- AP-HP, Hôpital Tenon, soins intensifs néphrologiques et rein aigu, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - M C Renaud
- Sorbonne Université, faculté de médecine, Paris, France
| | - A Duguet
- Sorbonne Université, faculté de médecine, Paris, France
| | - S Georgin-Lavialle
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France
| | - F Cohen-Aubart
- Sorbonne Université, faculté de médecine, Paris, France; AP-HP, Hôpital de la Pitié-Salpêtrière service de médecine interne 2, 47-83 boulevard de l'Hôpital, 75013 Paris, France
| | - G Ibanez
- Sorbonne Université, faculté de médecine, Paris, France; Sorbonne Université, département de médecine générale, Paris, France
| | - O Steichen
- AP-HP, Hôpital Tenon, service de médecine interne, 4 rue de la Chine, 75020 Paris, France; Sorbonne Université, faculté de médecine, Paris, France; INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, équipe Sentinelles, 27 rue de Chaligny, 75012 Paris, France
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Osborne C, Brown C, Mostafa A. Effectiveness of high- and low-fidelity simulation-based medical education in teaching cardiac auscultation: a systematic review and meta-analysis. Simul Healthc 2022. [DOI: 10.54531/nzws5167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Simulation-based medical education (SBME) is an evolving method of teaching cardiac examination skills to healthcare learners. It has been deliberated how effective this teaching modality is and whether high-fidelity methods are more effective than low-fidelity methods. This systematic review aimed to assess the effectiveness of high-fidelity SBME in teaching cardiac auscultation compared with no intervention or another active teaching intervention (low-fidelity SBME) using evidence from randomized controlled trials (RCTs).
Literature searches were performed on Medline, Embase, PsychInfo and Cinahl. RCTs that compared the effectiveness of high-fidelity simulation against no intervention or high-fidelity simulation against low-fidelity simulation in teaching cardiac auscultation to healthcare learners were included. Outcomes were knowledge, skills and satisfaction relating to cardiac auscultation education. Data were analyzed using Review Manager 5.3 software.
Seventeen RCTs (n = 1055) were included. Twelve RCTs (n = 692) compared high-fidelity simulation with no intervention. The pooled effect sizes for knowledge and skills were 1.39 (95% confidence interval [CI], 0.39–2.38;
This review’s findings suggest that high-fidelity SBME is an effective teaching method for cardiac auscultation education. Interestingly, there was no significant difference in knowledge or skills among learners when comparing high-fidelity simulation with low-fidelity simulation. Further research is needed to establish the effectiveness of different forms of SBME as educational interventions.
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Affiliation(s)
- Craig Osborne
- Emergency Department, Queen Elizabeth University Hospital, NHS Greater Glasgow & Clyde, Glasgow, UK
| | - Craig Brown
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Alyaa Mostafa
- School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Ayaz O, Ismail FW. Healthcare Simulation: A Key to the Future of Medical Education - A Review. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2022; 13:301-308. [PMID: 35411198 PMCID: PMC8994530 DOI: 10.2147/amep.s353777] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 03/25/2022] [Indexed: 06/14/2023]
Abstract
Aim Simulation originates from its application in the military and aviation. It is implemented at various levels of healthcare education and certification today. However, its use remains unevenly distributed across the globe due to misconception regarding its cost and complexity and to lack of evidence for its consistency and validity. Implementation may also be hindered by an array of factors unique to the locale and its norms. Resource-poor settings may benefit from diverting external funds for short-term simulation projects towards collaboration with local experts and local material sourcing to reduce the overall cost and achieve long-term benefits. The recent shift of focus towards patient safety and calls for reduction in training duration have burdened educators with providing adequate quantity and quality of clinical exposure to students and residents in a short time. Furthermore, the COVID-19 pandemic has severely hindered clinical education to curb the spread of illness. Simulation may be beneficial in these circumstances and improve learner confidence. We undertook a literature search on MEDLINE using MeSH terms to obtain relevant information on simulation-based medical education and how to best apply it. Integration of simulation into curricula is an essential step of its implementation. With allocations for deliberate practice and mastery learning under supervision of qualified facilitators, this technology is becoming essential in medical education. Purpose To review the adaptation, spectrum of use, importance, and resource challenges of simulation in medical education and how best to implement it according to learning theories and best practice guides. Conclusion Simulation offers students and residents with adequate opportunities to practice their clinical skills in a risk-free environment. Unprecedented global catastrophes provide opportunities to explore simulation as a viable training tool. Future research should focus on sustainability of simulation-based medical education in LMICs.
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Affiliation(s)
- Omair Ayaz
- Aga Khan University Medical College, Karachi, Sindh, Pakistan
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Zhang Z, Tang Z, Wang F, Yu J, Tang Y, Jiang B, Gou Y, Lu B, Tang A, Tang X. Achieving physical examination competence through optimizing hands-on practice cycles: a prospective cohort comparative study of medical students. PeerJ 2021; 9:e12544. [PMID: 34917424 PMCID: PMC8643100 DOI: 10.7717/peerj.12544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Accepted: 11/04/2021] [Indexed: 11/20/2022] Open
Abstract
Background Deliberate practice (DP) was proposed for effective clinical skill training, which highlights focused, repetitive practice and feedback as the key points for practice. Although previous studies have investigated the effect of feedback in DP, little is known about the proper repetitive cycles of clinical skills training especially in physical examination (PE) training. Methods We drew learning curves and designed a comparative study to find out the optimal number of hands-on practice cycles, an important aspect of DP, in abdominal PE training for medical students. A comparative study was conducted to validate the optimal number of hands-on practice by dividing students into two cohorts including Cohort A (high-frequency hand-on training) and B (low-frequency hand-on training). Results The learning curve study of 16 students exhibited a threshold of four repetitive practices when 81.25% students reached the competence score. A total of 74 students’ final exam scores were collected for analysis. Students in Cohort A (4–5 PEs) scored significantly higher than those in Cohort B (≤3 PEs) (84.41 ± 11.78 vs 76.83 ± 17.51] in the final exam (P = 0.030)). Conclusion High-frequency practice can improve students’ competence of abdominal PE skill. We recommend four cycles of hands-on practice for each student in a training course like PE training.
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Affiliation(s)
- Zinan Zhang
- Xiangya Medical School, Central South University, Changsha, China.,Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Zhenwei Tang
- Xiangya Medical School, Central South University, Changsha, China.,Department of Dermatology, Xiangya hospital of Central South University, Changsha, China
| | - Fang Wang
- Department of Endocrinology and Metabolism, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Jingjia Yu
- Department of Cardiovascular Medicine, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Youzhou Tang
- Department of Nephrology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Boyue Jiang
- Xiangya Medical School, Central South University, Changsha, China
| | - Yue Gou
- Xiangya Medical School, Central South University, Changsha, China
| | - Ben Lu
- Department of Haematology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Anliu Tang
- Department of Gastroenterology, The Third Xiangya Hospital of Central South University, Changsha, China
| | - Xiaohong Tang
- Department of Cardiovascular Medicine, The Third Xiangya Hospital of Central South University, Changsha, China.,The Clinical Skills Training Center, The Third Xiangya Hospital of Central South University, Changsha, China
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Inadequacies of Physical Examination in Patients with Acute Lower Limb Ischemia Are Associated with Dreadful Consequences. Ann Vasc Surg 2021; 82:190-196. [PMID: 34902465 DOI: 10.1016/j.avsg.2021.10.067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 10/20/2021] [Accepted: 10/21/2021] [Indexed: 11/24/2022]
Abstract
BACKGROUND Acute lower limb ischemia (ALI) is limb and life-threatening. The aim of this study was to explore the association between adherence to guidelines on clinical diagnosis of ALI and outcome at 1 year. The hypothesis was that that better examination was associated with favorable outcome in ALI patients. METHODS Retrospective cohort study between 2015 and 2018. In-hospital, operation, radiological and autopsy registries captured 161 citizens of Malmö with ALI. The initial bedside evaluation was performed by an emergency physician. Scoring was based on evaluation of the 6 "Ps" and 1 point was given for pain, pallor, pulselessness, perishing cold, paresthesia, paralysis or ankle-brachial pressure index (ABI). The performance was scored (range 0-7), and a score ≥5 was defined as a satisfactory vascular leg status. A multivariate logistic regression was performed to adjust for confounders and expressed in Odds Ratios (OR) with 95% confidence intervals (CI). RESULTS A satisfactory first clinical examination was performed in 55.3% of the patients. Measurement of ABI (OR 0.25, 95% CI 0.11-0.55), performing complete pulse status (OR 0.41, 95% CI 0.20-0.85), evaluating paralysis (OR 0.43, 95% CI 0.20-0.89), and a bedside score ≥5 points (OR 0.48, 95% CI 0.23-0.97) were independently associated with reduced risk of major amputation/mortality at 1-year follow up. CONCLUSIONS Quality of initial bedside evaluation in patients with ALI was unsatisfactory to a large extent and better clinical examinations were associated with favorable outcome at 1 year. Skills in clinical diagnostics in ALI needs to be much improved.
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Erdevir M, Uyaroğlu OA, Özdede M, Tanrıöver MD. "COVID-19: The final nail in the coffin for physical examination" Evaluation of the effects of COVID-19 pandemic on physical examination habits of residents in a university hospital: A cross-sectional survey. Int J Clin Pract 2021; 75:e14988. [PMID: 34674358 PMCID: PMC8646707 DOI: 10.1111/ijcp.14988] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2021] [Revised: 09/16/2021] [Accepted: 10/19/2021] [Indexed: 11/28/2022] Open
Abstract
AIMS It is evident that the COVID-19 pandemic has affected the medical practice and training of residents. In this study, we evaluated the physical examination (PE) habits of residents working in a university hospital and how their PE practices did change during the pandemic. METHODS This single-centre, non-interventional, cross-sectional descriptive study was conducted in a university hospital using an online survey questionnaire between 5 and 20 October 2020. RESULTS Of the 308 residents who participated in the study, 172 of them (55.8%) were female and the median age was 27 (IQR (3) = Q1 (29)-Q3 (26)). Amongst all, 263 participants (85.4%) declared that they have worked in the areas where suspected/confirmed COVID-19 patients were being served. A total of 262 (85%) residents stated that PE habits have changed generally during the pandemic. There was a significant difference with regards to the change in PE habits between those residents who have worked in the COVID-19 areas (n = 230, 87.5%) and those who have not (n = 32, 71.1%) (P = .004). PE habits of Internal Medicine Residents were changed more than others (P < .001). The main reason for the change in PE habits in general (77.9%) and during the examination of suspected/confirmed COVID-19 patients (89.7%) were "self-protection." Independent factors for limited PE in suspected/confirmed COVID-19 patients were found as "Avoiding performing physical examination to be exposed less/to protect (adjusted ORs = 13.067)," "relying on laboratory and radiological investigations during practice (adjusted ORs = 4.358)," and "not having a thought that reduced physical examination will render the diagnosis and course of COVID-19 (adjusted ORs = 2.244)." CONCLUSIONS This study clearly demonstrated that the COVID-19 pandemic has had a serious impact on the PE habits of the residents while examining patients in general and with COVID-19.
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Affiliation(s)
- Mehmet Erdevir
- Department of Internal MedicineHacettepe University Faculty of MedicineAnkaraTurkey
| | - Oğuz Abdullah Uyaroğlu
- Division of General Internal MedicineDepartment of Internal MedicineHacettepe University Faculty of MedicineAnkaraTurkey
| | - Murat Özdede
- Division of General Internal MedicineDepartment of Internal MedicineHacettepe University Faculty of MedicineAnkaraTurkey
| | - Mine Durusu Tanrıöver
- Division of General Internal MedicineDepartment of Internal MedicineHacettepe University Faculty of MedicineAnkaraTurkey
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Han SG, Kim YD, Kong TY, Cho J. Virtual reality-based neurological examination teaching tool(VRNET) versus standardized patient in teaching neurological examinations for the medical students: a randomized, single-blind study. BMC MEDICAL EDUCATION 2021; 21:493. [PMID: 34526004 PMCID: PMC8444400 DOI: 10.1186/s12909-021-02920-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/01/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND The conventional methods for teaching neurological examination with real patients to medical students have some limitations if the patient with the symptom or disease is not available. Therefore, we developed a Virtual Reality-based Neurological Examination Teaching Tool (VRNET) and evaluated its usefulness in in teaching neurological examinations for the medical students. METHODS In this prospective, randomized, single-blind study, we recruited 98 medical students and divided them into two groups: 1) A standardized patient(SP) group that received the clinical performance examination utilizing standard patients complaining of dizziness was provided neurological findings using conventional method such as verbal description, photographs, and video clips; 2) A SP with VRNET group that was provided the neurological findings using the newly developed tool. Among the 98 students, 3 did not agree to participate, and 95 were enrolled in this study. The SP group comprised 39 students and the SP with VRNET group had 56 students. RESULTS There were no statistical differences in VRNET's realness and student satisfaction between the SP and SP with VRNET groups. However, a statistically significant difference was found in the Neurologic Physical Exam (NPE) score (p = 0.043); the SP with VRNET group had higher NPE scores (3.81 ± 0.92) than the SP group (3.40 ± 1.01). CONCLUSIONS VRNET is useful in teaching senior (graduating) medical students with SP with a neurologic problem.
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Affiliation(s)
- Sang Gil Han
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Tae Young Kong
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea
| | - Junho Cho
- Department of Emergency Medicine, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea.
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Iragavarapu T, Sunkarapalli G, Vutukuru S, Kataria A. “Art at its Heart” “The Golden Art of History and Clinical Examination”. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_38_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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12
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Freed JA, Hale AJ, Rangachari D, Ricotta DN. Twelve tips for teaching oncology to non-oncologists. MEDICAL TEACHER 2020; 42:987-992. [PMID: 31663798 DOI: 10.1080/0142159x.2019.1682534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Background: Teaching subspecialty care to trainees who are not pursuing that subspecialty poses many challenges. These challenges are amplified in the teaching of oncology to non-oncologists because there are more new therapies emerging in oncology than in any other discipline, and there are few oncologic issues managed by generalists without consultation. Concurrently, there is an increasing need for generalists to manage many aspects of care for patients with cancer.Aim: To provide 12 tips for oncologists to use to educate trainees on their oncology rotations.Method: The tips provided are based upon the available literature and the authors' own experience.Results: The 12 tips presented offer specific strategies for oncologists to enhance their teaching by selection of appropriate content and enhancing delivery. Focus is placed on aspects of oncology that trainees are likely to encounter as a generalist or non-cancer subspecialist. While oncology is used as the case study, these strategies are adaptable to any subspecialty area.Conclusion: Oncologists and other subspecialists can be core medical educators.
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Affiliation(s)
- Jason A Freed
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Andrew J Hale
- Division of Infectious Disease, University of Vermont Larner College of Medicine, Burlington, VT, USA
| | - Deepa Rangachari
- Division of Hematology/Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Daniel N Ricotta
- Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
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Marom A. The Birth, Death, and Renaissance (?) of Dissection: A Critique of Anatomy Teaching With-or Without-the Human Body. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2020; 95:999-1005. [PMID: 31764082 DOI: 10.1097/acm.0000000000003090] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A riveting debate regarding the fate of dissection, the classical method of anatomy, is sweeping through medical academia, as imaging tools gain a greater foothold in anatomy teaching programs. This Perspective does not aim to grapple with the question of "how should anatomy be taught" but rather to explain why the transformation of anatomical education is taking place by situating these developments in the broader philosophical context of modern medicine, offered by Michel Foucault's The Birth of the Clinic: An Archaeology of Medical Perception. Emphasizing the body's crucial role in the epistemological change in medical practice in the early 19th century, Foucault coined the term "medical gaze" to denote the doctor's observation of the patient's body in search of signs of disease. Within this new systematic perception of disease, which brought about the anatomo-clinical method, the clinical gaze thus embraced the study of the body via dissection. The author contends that the introduction of medical imaging into the diagnostic process has resulted in a shift in the focus of the clinical gaze from the body to its medical image and that this process is mirrored in anatomy by its discarding of the cadaver. Given the fundamental differences between the phenomenology of the body and its medical image, the author suggests that when using medical images in medical schools and teaching hospitals, one teaches, at the very least, a new kind of anatomy. Foucault's analysis of the painting The Treachery of Images by Réne Magritte lends some support to the ideas presented here.
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Affiliation(s)
- Assaf Marom
- A. Marom is head of anatomy education, The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel; ORCID: https://orcid.org/0000-0003-0537-4661
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14
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Bacorn C, Gokoffski KK, Lin LK. Clinical correlation recommended: accuracy of clinician versus radiologic interpretation of the imaging of orbital lesions. Orbit 2020; 40:133-137. [PMID: 32279603 DOI: 10.1080/01676830.2020.1752742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Purpose: To assess the accuracy of radiographic interpretation between the clinician and radiologist when compared to histopathology of orbital lesions. Methods: A retrospective chart review of patients at the University of California Davis Eye Center who underwent orbitotomy from 1/1/2000 to 5/22/2019 was performed. Charts with a preoperative imaging report, preoperative clinical assessment including the clinician's interpretation of imaging, and histopathologic diagnosis were included. The specific diagnoses were grouped into related classes of pathology for the analysis. The clinical and radiologic assessments were compared against the final histopathologic diagnosis for concordance. A concordance analysis was performed. Results: 242 patients (mean age 49 years, 53.5% female) were reviewed. Of these records 185 documented the clinician's clinical impression, the radiology report, as well as the histopathology report. The clinician's preoperative assessment had substantial agreement [kappa = 0.72 (0.65,0.79)] with the final histopathologic result and was correct in 75.7% (140/185) of cases whereas the radiology report was correct in 52.4% (97/185) with a moderate level of agreement [kappa = 0.47 (0.39, 0.55)]. In 49.2% (91/185) of cases the final histopathology correlated with both the clinical impression and radiology report [kappa = 0.58 (0.55, 0.61)]. Conclusions: The accurate interpretation of orbital imaging is a challenge and histopathologic examination remains the gold standard for diagnosis. While orbital imaging is a valuable diagnostic tool the interpretation of these studies is most accurate when conducted in the context of the patient's medical history, clinical exam, and with the physician most familiar with various orbital lesions.
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Affiliation(s)
- Colin Bacorn
- Department of Ophthalmology and Vision Science, University of California Davis Health , Sacramento, California, USA
| | - Kimberly K Gokoffski
- Department of Ophthalmology, University of Southern California , Los Angeles, California, USA
| | - Lily Koo Lin
- Department of Ophthalmology and Vision Science, University of California Davis Health , Sacramento, California, USA
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Sabet F, Zoghoul S, Alahmad M, Al Qudah H. The influence of gender on clinical examination skills of medical students in Jordan: a cross-sectional study. BMC MEDICAL EDUCATION 2020; 20:98. [PMID: 32234037 PMCID: PMC7110726 DOI: 10.1186/s12909-020-02002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/09/2019] [Accepted: 03/12/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND A graduating medical doctor is expected to be competent in physical examinations across all systems. The exploration of how gender affects the development of clinical skills has not been explored in an Arab context, despite cultural restrictions that make it more difficult for students and doctors to examine the opposite sex. METHODS A cross sectional survey was undertaken of graduating final year medical students in Northern Jordan. We asked about students' perceptions regarding factors that may impact the development of clinical skills potentially related to gender, and asked about the frequency of examinations performed during their training for intimate and general physical examinations on all patients, as well as patients of the opposite sex. We also asked about the students' confidence in performing the examinations (3-point Likert-scale). Comparison of male and female proportions was done using Chi square tests analysis. RESULTS One hundred eighty-eight final year students from 481 students (41%) completed the survey, 99 males and 89 females. The greatest factor given for impacting a student's clinical examination of a patient of the opposite sex was cultural or religious traditions. Overall male students perform more clinical examinations than female students, with the odds of a male conducting more than 10 cardiovascular examinations on any patient compared to female students being 2.07 (1.13-3.79) and as high as 3.06 (1.53-6.18) for thyroid examinations. However, females were significantly more likely to examine male patients than vice versa (0.49 (0.27-0.88) for cardiovascular and 0.39 (0.21-0.71) for respiratory examinations). The gender division was more prominent for intimate examinations, with a lower odds of males conducting breast 0.11 (0.04-0.28) and vaginal examinations 0.22 (0.02-1.98) and more male students conducting prostate examinations OR 11.00 (1.39-87.03) and male genitalia examinations OR 16.31 (3.75-70.94). Overall a large proportion of students had never performed common intimate clinical examinations at all. CONCLUSIONS In our context, clinical exposure to both intimate and general clinical examinations differs significantly between male and female students. A greater awareness and more research on the influence of gender on clinical skill attainment in conservative cultures is needed with appropriate adaption of clinical teaching. TRIAL REGISTRATION Non interventional thus not required.
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Affiliation(s)
- Farnaz Sabet
- Formerly at Department of Public Health and Community Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Sohaib Zoghoul
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Murad Alahmad
- Department of General Surgery and Urology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
| | - Heba Al Qudah
- Department of Diagnostic Radiology, Faculty of Medicine, Jordan University of Science and Technology, Irbid, Jordan
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Russo S, Berg K, Davis J, Davis R, Riesenberg LA, Morgan C, Chambers L, Berg D. Incoming Interns Recognize Inadequate Physical Examination as a Cause of Patient Harm. JOURNAL OF MEDICAL EDUCATION AND CURRICULAR DEVELOPMENT 2020; 7:2382120520928993. [PMID: 32577530 PMCID: PMC7288807 DOI: 10.1177/2382120520928993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 05/04/2020] [Indexed: 06/11/2023]
Abstract
INTRODUCTION As providers of a large portion of the care delivered at academic health centers, medical trainees have a unique perspective on medical error. Despite data suggesting that errors in physical examination (PE) can lead to adverse patient events, we are not aware of previous studies exploring medical trainee perceptions of the relationship between patient harm and inadequate PE. We investigated whether first-year residents at a large tertiary care academic medical center perceive inadequate PE as a cause of adverse patient events. METHODS As part of a larger survey given to incoming interns at Thomas Jefferson University Hospital orientation (2014-2018), the authors examined the perceptions of inadequate PE and adverse patient events. We also examined other details related to PE educational experiences and self-reported PE proficiency. The survey was developed a priori by the authors and assessed for face validity by expert faculty. RESULTS Ninety-eight percent of respondents (695/706) reported that inadequate PE leads to adverse patient events. Seventy percent (492/706) believe that inadequate PE causes adverse events in up to 10% of all patient encounters, and 30% (214/706) reported that inadequate PE causes adverse events in greater than 10% of patient encounters. Forty-five percent of surveyed interns (319/715) had witnessed a patient safety issue as a result of an inadequate PE. Only 2% of surveyed interns (11/706) did not think patients experience adverse events because of inadequate PEs. Ninety percent of surveyed interns (643/712) reported feeling proficient in performing PE. From 2015 to 2018, 80% (486/604) indicated that they received "just enough" PE education. CONCLUSION Nearly all incoming interns surveyed at our institution believe that inadequate PE leads to adverse patient events, and 45% have witnessed an adverse patient event due to inadequate PE. We urge clinicians, educators, and health care administrators to consider enhanced PE skills training as an important and viable approach to medical error reduction, and as such, we propose a 5-pronged intervention for improvement, including a redesign of PE curricula, development of checklist-based assessment methods, ongoing skills training and assessment of physicians-in-practice, rigorous study of PE maneuvers, and research into whether enhanced PE skills improve patient outcomes.
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Affiliation(s)
- Stefani Russo
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Katherine Berg
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
| | - Joshua Davis
- Department of Emergency Medicine, Penn
State Hershey Medical Center, Hershey, PA, USA
| | - Robyn Davis
- Department of Anesthesiology and
Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Lee Ann Riesenberg
- Department of Anesthesiology and
Perioperative Medicine, The University of Alabama at Birmingham, Birmingham, AL,
USA
| | - Charity Morgan
- Department of Biostatistics, School of
Public Health, The University of Alabama at Birmingham, Birmingham, AL, USA
| | - Lucas Chambers
- University of Virginia School of
Medicine, Charlottesville, VA, USA
| | - Dale Berg
- Sidney Kimmel Medical College, Thomas
Jefferson University, Philadelphia, PA, USA
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Huang SS, Huang CC, Yang YY, Wang SJ, Shulruf B, Chen CH. Dreyfus scale-based feedback increases the medical student's satisfaction with the complex cluster part of the interviewing and physical examination course and skills' readiness in Taiwan. JOURNAL OF EDUCATIONAL EVALUATION FOR HEALTH PROFESSIONS 2019; 16:30. [PMID: 31614407 PMCID: PMC6848653 DOI: 10.3352/jeehp.2019.16.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Accepted: 10/11/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE Different from the basic core part of the clinical interviewing and physical examination (PE) skills course in basic, head-to-toe, and thorax systems, learners need structural feedback for the development of the complex skills in cluster part including abdominal, neuromuscular and musculoskeletal systems. It aimed to evaluate the effects of replacing Dreyfus scale, which having elements of continuous professional development, with Likert scale in the feedback in cluster part of training in Taiwan. METHODS Instructors and final-year medical students of class 2015-2016 comprised the regular cohort, whereas those of class 2017-2018 formed the intervention cohort. In the intervention cohort, Dreyfus scale-based feedback rather than Likert scale based feedback was used in the cluster part of the course in National Yang-Ming university, Taiwan. RESULTS Among the regular cohort, poor pre-trained standardized patients (SPs) rated class climate, low grouped students satisfaction with the instructors and course, and low grouped student self-assessed readiness were noted in the cluster part than those in the core part. In comparison with regular cohort, greater improvement of post-cluster part end-of-course group objective structured clinical examination (GOSCE) scores was noted in intervention cohort. In other word, the implementation of Dreyfus scale-based feedback in the cluster part improved the deficit in this part of the course among the intervention cohort. CONCLUSION The implementation of Dreyfus scale-based feedback helped instructors to create a good class climate in the cluster parts of clinical interviewing plus PE skills course in our study. Simultaneously, this new intervention achieved the goal of medical students competency in interviewing, PE and self-directed learning (SDL) skills.
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Affiliation(s)
- Shiau-Shian Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Bali Psychiatric Center, Ministry of Health and Welfare, Taipei, Taiwan
| | - Chia-Chang Huang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ying-Ying Yang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
- Division of General Medicine, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shuu-Jiun Wang
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Boaz Shulruf
- Office of Medical Education, University of New South Wales Australia, Sydney, Australia
| | - Chen-Huan Chen
- Department of Medicine, National Yang-Ming University, Taipei, Taiwan
- Division of Clinical Skills Training, Department of Medical Education, Taipei Veterans General Hospital, Taipei, Taiwan
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18
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Dale PC, Thomas JC, Hazle CR. Physical therapist clinical reasoning and classification inconsistencies in headache disorders: a United States survey. J Man Manip Ther 2019; 28:28-40. [PMID: 31373539 DOI: 10.1080/10669817.2019.1645414] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objective: The purpose of this study was to investigate the decision-making processes of physical therapists relating to evaluation and categorization of patients with headaches, including consistency with criteria proposed by the International Headache Society (IHS).Methods: A national online survey was distributed in cooperation with the Academy of Orthopaedic Physical Therapy of the American Physical Therapy Association. Three hypothetical patient case vignettes featuring headache disorders were used as assessment instruments. Additionally, data on physical therapist education, clinical experience, manual therapy training, self-efficacy, and familiarity & consistency with IHS criteria were collected. Physical therapist identification and valuation of clinical features of headache disorders were also examined in the decision-making processes.Results: Among the 384 respondents, 32.3% classified the tension-type headache case consistent with IHS criteria. The cervicogenic and migraine headache cases were classified at 54.8% and 41.7% consistent with IHS categories, respectively. Experienced clinicians and those with formal manual training categorized patient presentations with greater consistency. Clinician familiarity with IHS classification criteria was low with 73.6% collectively somewhat and not familiar, while 26.4% of physical therapists were self-described as very or moderately familiar.Discussion: Clinicians' headache categorization was significantly affected by symptom misattribution and weighting of individual examination findings. Weighting by practitioners of clinical features varied markedly with greatest emphasis being placed on detailed manual examination procedures, including passive intervertebral movements. Inconsistencies in valuation of clinical features in headache categorization suggest a need for further formal education in physical therapy educational curricula and in post-graduate education, including of IHS criteria and classification.Level of Evidence: 2a.
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Affiliation(s)
- Philip C Dale
- KORT-Bryan Station, Kentucky Orthopedic Rehab Team, Lexington, KY, USA
| | - Jacob C Thomas
- Orthopedics Plus Physical Therapy, Medical Center at Bowling Green, Bowling Green, KY, USA
| | - Charles R Hazle
- Division of Physical Therapy, University of Kentucky, Hazard, KY, USA
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19
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A global perspective on the challenges and opportunities in learning about rheumatic and musculoskeletal diseases in undergraduate medical education. Clin Rheumatol 2019; 39:627-642. [DOI: 10.1007/s10067-019-04544-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Accepted: 04/01/2019] [Indexed: 10/26/2022]
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Jerg A, Denkinger M, Jerg-Bretzke L. Development of an innovative physical examination course involving handheld ultrasound devices. MEDEDPUBLISH 2019; 7:164. [PMID: 38074619 PMCID: PMC10701831 DOI: 10.15694/mep.2018.0000164.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.
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Affiliation(s)
- Achim Jerg
- University Hospital Ulm
- University Hospital Ulm
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21
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Jerg A, Denkinger M, Jerg-Bretzke L. Development of an innovative physical examination course involving handheld ultrasound devices. MEDEDPUBLISH 2019; 7:164. [PMID: 38074619 PMCID: PMC10701831 DOI: 10.15694/mep.2018.0000164.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/28/2024] Open
Abstract
This article was migrated. The article was marked as recommended. Several studies in recent years have shown that the physical examination skills of medical students are inadequate. In response to this deficit, a new teaching intervention has been developed consisting of five physical examination courses and a set of corresponding bedside teaching modules. The bedside modules are primarily intended to provide the opportunity for practical application of the examination techniques learned. One particularity of the bedside teaching was the use of handheld ultrasound (HHU) units in order to be able to visualize and verify/falsify diagnostic findings immediately. Since this demonstration of findings was standardized according to the specifications of the Rapid Ultrasound in Shock and Hypotension (RUSH) protocol, it constituted the basis for the communication of basic emergency ultrasound skills. A pilot study, which included an initial evaluation, has demonstrated this concept is feasible and is met with great interest on the part of the students.
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Affiliation(s)
- Achim Jerg
- University Hospital Ulm
- University Hospital Ulm
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22
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Rausch N, Harendza S. Successful completion of clinical electives - Identification of significant factors of influence on self-organized learning during clinical electives with student focus groups. GMS JOURNAL FOR MEDICAL EDUCATION 2018; 35:Doc39. [PMID: 30186949 PMCID: PMC6120151 DOI: 10.3205/zma001185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Revised: 05/29/2018] [Accepted: 06/12/2018] [Indexed: 06/08/2023]
Abstract
Background: The Medical Licensure Act prescribes a total of four months of clinical electives in which the medical students are to work in a self-organized manner in outpatient and inpatient care. Since no specific learning objectives or learning content are given and students come into contact with different structures of outpatient and inpatient care, the learning success in a clinical elective is often rather random. In order to make self-organized learning (SOL) in clinical electives as effective as possible, we identified factors in the area of inpatient care that have an influence on SOL and thus the learning success during a clinical elective. Methods: To investigate this question a qualitative and explorative approach was chosen. In 2015, a total of 21 students from semester 1 to 11 participated in six semi-structured focus group discussions at Hamburg Medical Faculty. In these, the students were asked about their experiences and expectations with regard to SOL in clinical electives. The interviews were transcribed literally and analyzed using Grounded Theory in parallel to further data collection. Results: Three main categories were identified, which had an impact on SOL in clinical electives, each with two sub-categories: People (elective students and physicians), learning itself (learning content and learning process) and the framework (local conditions and organizational structure). For example, elective students exhibiting openness and self-initiative as well as a good working atmosphere and few hierarchical structures were conducive to SOL, while shyness and lack of integration into the ward's medical team inhibited SOL. A mentor formally assigned to the student can promote SOL through guidance, supervision and the transfer of responsibility. Continuous feedback from mentors or peers promotes SOL. Framework conditions, such as a smooth administrative organization, also affect SOL, but elective students have limited influence over these. Conclusion: The creation of suitable framework conditions and considering the needs of the people involved in clinical electives and the requirements of learning itself are necessary steps in order to enable successful SOL during clinical electives. Suitable framework conditions could be compiled and widely disseminated on an empirical basis. Training for teachers and elective students on various aspects of clinical electives, from professional behavior to practical skills, could be a suitable preparatory measure to promote SOL in clinical electives and contribute to a better learning success of the elective students.
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Affiliation(s)
- Natalie Rausch
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
| | - Sigrid Harendza
- Universitätsklinikum Hamburg-Eppendorf, III. Medizinische Klinik, Hamburg, Germany
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23
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Neal AE, Lehto E, Miller KH, Ziegler C, Davis E. Using a statewide survey methodology to prioritize pediatric cardiology core content. CONGENIT HEART DIS 2017; 13:147-153. [DOI: 10.1111/chd.12559] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Accepted: 10/15/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Ashley E. Neal
- Department of Pediatrics; University of Louisville School of Medicine; Louisville Kentucky, USA
| | - Elizabeth Lehto
- Department of Pediatrics; University of Louisville School of Medicine; Louisville Kentucky, USA
| | - Karen Hughes Miller
- Graduate Medical Education; University of Louisville School of Medicine; Louisville Kentucky, USA
| | - Craig Ziegler
- Graduate Medical Education; University of Louisville School of Medicine; Louisville Kentucky, USA
| | - Erin Davis
- Graduate Medical Education; University of Louisville School of Medicine; Louisville Kentucky, USA
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Shields HM, Fernandez-Becker NQ, Flier SN, Vaughn BP, Tukey MH, Pelletier SR, Horst DA. Volunteer patients and small groups contribute to abdominal examination's success. ADVANCES IN MEDICAL EDUCATION AND PRACTICE 2017; 8:721-729. [PMID: 29138611 PMCID: PMC5676735 DOI: 10.2147/amep.s146500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND Prior to 2007, we taught the abdominal examination in a hospital based group to 40 students, at one hospital. We used volunteer patients, small groups, repetition, and required faculty development sessions. In 2007, our medical school changed its "Introduction to Physical Examination" session so that the entire class was to be taught in a geographically central session. Our hospital was selected to lead the abdominal examination portion of the session. AIM Our aim was to answer three questions. First, could we quadruple the recruitment of volunteer patients, and faculty? Second, was it volunteer patients, small groups, repetition, or faculty training that was most valued by the students? Third, would volunteer patients and/or faculty agree to participate a second time? METHODS A total of 43-46 patients and 43-46 faculty were recruited and 43-46 examining rooms were obtained for each of the 5 years of this study. Teachers were required to attend a 1-hour faculty development session. The class of about 170 students was divided into 43-46 groups each year. The teacher demonstrated the abdominal examination and each student practiced the examination on another student. Each student then repeated the full abdominal examination on a volunteer patient. RESULTS Over the 5-year time period (2008-2012), the abdominal examination ranked first among all organ systems' "Introductory Sessions". The abdominal examination ratings had the best mean score (1.35) on a Likert scale where 1 is excellent and 5 is poor. The students gave the most positive spontaneous comments to having volunteer patients, with small groups coming in as the second most appreciated educational element. CONCLUSION We successfully quadrupled the number of faculty, patients, and examining rooms and created a highly rated educational program as measured by anonymous student evaluations, patient and faculty participation, and the medical school's selecting the abdominal examination methods as an "Advanced Examination" for the Pathways Curriculum.
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Affiliation(s)
- Helen M Shields
- Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA
| | | | - Sarah N Flier
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Byron P Vaughn
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | - Melissa H Tukey
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
| | | | - Douglas A Horst
- Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA
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Garibaldi BT, Niessen T, Gelber AC, Clark B, Lee Y, Madrazo JA, Manesh RS, Apfel A, Lau BD, Liu G, Canzoniero JV, Sperati CJ, Yeh HC, Brotman DJ, Traill TA, Cayea D, Durso SC, Stewart RW, Corretti MC, Kasper EK, Desai SV. A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training. BMC MEDICAL EDUCATION 2017; 17:182. [PMID: 28985729 PMCID: PMC6389200 DOI: 10.1186/s12909-017-1020-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 09/25/2017] [Indexed: 05/21/2023]
Abstract
BACKGROUND Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. METHODS One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). RESULTS Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. CONCLUSIONS A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
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Affiliation(s)
- Brian Thomas Garibaldi
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287 USA
| | - Timothy Niessen
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Allan Charles Gelber
- Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, Baltimore, MD 21224 USA
| | - Bennett Clark
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Yizhen Lee
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Jose Alejandro Madrazo
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Reza Sedighi Manesh
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Ariella Apfel
- Department of General Internal Medicine, 2024 E Monument St, Baltimore, MD 21205 USA
| | - Brandyn D. Lau
- Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Gigi Liu
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Jenna VanLiere Canzoniero
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - C. John Sperati
- Division of Nephrology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Hsin-Chieh Yeh
- Department of General Internal Medicine, 2024 E Monument St, Baltimore, MD 21205 USA
| | - Daniel J. Brotman
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Thomas A. Traill
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Danelle Cayea
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Samuel C. Durso
- Division of Geriatric Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue 7th Floor, Baltimore, MD 21224 USA
| | - Rosalyn W. Stewart
- Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Mary C. Corretti
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Edward K. Kasper
- Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD 21287 USA
| | - Sanjay V. Desai
- Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD 21287 USA
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Świerszcz J, Stalmach-Przygoda A, Kuźma M, Jabłoński K, Cegielny T, Skrzypek A, Wieczorek-Surdacka E, Kruszelnicka O, Chmura K, Chyrchel B, Surdacki A, Nowakowski M. How does preclinical laboratory training impact physical examination skills during the first clinical year? A retrospective analysis of routinely collected objective structured clinical examination scores among the first two matriculating classes of a reformed curriculum in one Polish medical school. BMJ Open 2017; 7:e017748. [PMID: 28864488 PMCID: PMC5588968 DOI: 10.1136/bmjopen-2017-017748] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE As a result of a curriculum reform launched in 2012 at our institution, preclinical training was shortened to 2 years instead of the traditional 3 years, creating additional incentives to optimise teaching methods. In accordance with the new curriculum, a semester-long preclinical module of clinical skills (CS) laboratory training takes place in the second year of study, while an introductory clinical course (ie, brief introductory clerkships) is scheduled for the Fall semester of the third year. Objective structured clinical examinations (OSCEs) are carried out at the conclusion of both the preclinical module and the introductory clinical course. Our aim was to compare the scores at physical examination stations between the first and second matriculating classes of a newly reformed curriculum on preclinical second-year OSCEs and early clinical third-year OSCEs. DESIGN Analysis of routinely collected data. SETTING One Polish medical school. PARTICIPANTS Complete OSCE records for 462 second-year students and 445 third-year students. OUTCOME MEASURES OSCE scores by matriculation year. RESULTS In comparison to the first class of the newly reformed curriculum, significantly higher (ie, better) OSCE scores were observed for those students who matriculated in 2013, a year after implementing the reformed curriculum. This finding was consistent for both second-year and third-year cohorts. Additionally, the magnitude of the improvement in median third-year OSCE scores was proportional to the corresponding advancement in preceding second-year preclinical OSCE scores for each of two different sets of physical examination tasks. In contrast, no significant difference was noted between the academic years in the ability to interpret laboratory data or ECG - tasks which had not been included in the second-year preclinical training. CONCLUSION Our results suggest the importance of preclinical training in a CS laboratory to improve students' competence in physical examination at the completion of introductory clinical clerkships during the first clinical year.
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Affiliation(s)
- Jolanta Świerszcz
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | | | - Marcin Kuźma
- Students' Scientific Group at the Second Department of Cardiology, School of Medicine in English, Jagiellonian University Medical College, Cracow, Poland
| | - Konrad Jabłoński
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | - Tomasz Cegielny
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | - Agnieszka Skrzypek
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | | | - Olga Kruszelnicka
- Department of Coronary Artery Disease and Heart Failure, The John Paul II Hospital in Cracow, Cracow, Poland
| | - Kaja Chmura
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
| | - Bernadeta Chyrchel
- Second Department of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Andrzej Surdacki
- Second Department of Cardiology, Jagiellonian University Medical College, Cracow, Poland
| | - Michał Nowakowski
- Department of Medical Education, Jagiellonian University Medical College, Cracow, Poland
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Teaching a Hypothesis-driven Physical Diagnosis Curriculum to Pulmonary Fellows Improves Performance of First-Year Medical Students. Ann Am Thorac Soc 2017; 13:489-94. [PMID: 26730644 DOI: 10.1513/annalsats.201505-297oc] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
RATIONALE Hypothesis-driven physical examination emphasizes the role of bedside examination in the refinement of differential diagnoses and improves diagnostic acumen. This approach has not yet been investigated as a tool to improve the ability of higher-level trainees to teach medical students. OBJECTIVES To assess the effect of teaching hypothesis-driven physical diagnosis to pulmonary fellows on their ability to improve the pulmonary examination skills of first-year medical students. METHODS Fellows and students were assessed on teaching and diagnostic skills by self-rating on a Likert scale. One group of fellows received the hypothesis-driven teaching curriculum (the "intervention" group) and another received instruction on head-to-toe examination. Both groups subsequently taught physical diagnosis to a group of first-year medical students. An oral examination was administered to all students after completion of the course. MEASUREMENTS AND MAIN RESULTS Fellows were comfortable teaching physical diagnosis to students. Students in both groups reported a lack of comfort with the pulmonary examination at the beginning of the course and improvement in their comfort by the end. Students trained by intervention group fellows outperformed students trained by control group fellows in the interpretation of physical findings (P < 0.05). CONCLUSIONS Teaching hypothesis-driven physical examination to higher-level trainees who teach medical students improves the ability of students to interpret physical findings. This benefit should be confirmed using validated testing tools.
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Störmann S, Stankiewicz M, Raes P, Berchtold C, Kosanke Y, Illes G, Loose P, Angstwurm MW. How well do final year undergraduate medical students master practical clinical skills? GMS JOURNAL FOR MEDICAL EDUCATION 2016; 33:Doc58. [PMID: 27579358 PMCID: PMC5003129 DOI: 10.3205/zma001057] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 03/11/2016] [Accepted: 05/10/2016] [Indexed: 05/28/2023]
Abstract
INTRODUCTION The clinical examination and other practical clinical skills are fundamental to guide diagnosis and therapy. The teaching of such practical skills has gained significance through legislative changes and adjustments of the curricula of medical schools in Germany. We sought to find out how well final year undergraduate medical students master practical clinical skills. METHODS We conducted a formative 4-station objective structured clinical examination (OSCE) focused on practical clinical skills during the final year of undergraduate medical education. Participation was voluntary. Besides the examination of heart, lungs, abdomen, vascular system, lymphatic system as well as the neurological, endocrinological or orthopaedic examination we assessed other basic clinical skills (e.g. interpretation of an ECG, reading a chest X-ray). Participants filled-out a questionnaire prior to the exam, inter alia to give an estimate of their performance. RESULTS 214 final year students participated in our study and achieved a mean score of 72.8% of the total score obtainable. 9.3% of participants (n=20) scored insufficiently (<60%). We found no influence of sex, prior training in healthcare or place of study on performance. Only one third of the students correctly estimated their performance (35.3%), whereas 30.0% and 18.8% over-estimated their performance by 10% and 20% respectively. DISCUSSION Final year undergraduate medical students demonstrate considerable deficits performing practical clinical skills in the context of a formative assessment. Half of the students over-estimate their own performance. We recommend an institutionalised and frequent assessment of practical clinical skills during undergraduate medical education, especially in the final year.
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Affiliation(s)
- Sylvère Störmann
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Melanie Stankiewicz
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Patricia Raes
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Christina Berchtold
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Yvonne Kosanke
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Gabrielle Illes
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Peter Loose
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
| | - Matthias W. Angstwurm
- Klinikum der Universität München, Medizinische Klinik und Poliklinik IV, München, Germany
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Williams DE, Thornton JW. Flipping the Physical Examination: Web-Based Instruction and Live Assessment of Bedside Technique. Ochsner J 2016; 16:70-72. [PMID: 27046409 PMCID: PMC4795508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/05/2023] Open
Abstract
BACKGROUND The skill of physicians teaching the physical examination skill has decreased, with newer faculty underperforming compared to their seniors. Improved methods of instruction with an emphasis on physical examinations are necessary to both improve the quality of medical education and alleviate the teaching burden of faculty physicians. METHODS We developed a curriculum that combines web-based instruction with real-life practice and features individualized feedback. RESULTS This innovative medical education model should allow the physical examination to be taught and assessed in an effective manner. The model is under study at Baton Rouge General Medical Center. CONCLUSION Our goals are to limit faculty burden, maximize student involvement as learners and evaluators, and effectively develop students' critical skills in performing bedside assessments.
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Affiliation(s)
- Dustyn E. Williams
- Department of Internal Medicine, Baton Rouge General Medical Center, Baton Rouge, LA
| | - John W. Thornton
- Department of Internal Medicine, Tulane University School of Medicine, New Orleans, LA
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Verghese A, Charlton B, Kassirer JP, Ramsey M, Ioannidis JPA. Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes. Am J Med 2015; 128:1322-4.e3. [PMID: 26144103 DOI: 10.1016/j.amjmed.2015.06.004] [Citation(s) in RCA: 123] [Impact Index Per Article: 13.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/08/2015] [Accepted: 06/08/2015] [Indexed: 11/29/2022]
Abstract
BACKGROUND Oversights in the physical examination are a type of medical error not easily studied by chart review. They may be a major contributor to missed or delayed diagnosis, unnecessary exposure to contrast and radiation, incorrect treatment, and other adverse consequences. Our purpose was to collect vignettes of physical examination oversights and to capture the diversity of their characteristics and consequences. METHODS A cross-sectional study using an 11-question qualitative survey for physicians was distributed electronically, with data collected from February to June of 2011. The participants were all physicians responding to e-mail or social media invitations to complete the survey. There were no limitations on geography, specialty, or practice setting. RESULTS Of the 208 reported vignettes that met inclusion criteria, the oversight was caused by a failure to perform the physical examination in 63%; 14% reported that the correct physical examination sign was elicited but misinterpreted, whereas 11% reported that the relevant sign was missed or not sought. Consequence of the physical examination inadequacy included missed or delayed diagnosis in 76% of cases, incorrect diagnosis in 27%, unnecessary treatment in 18%, no or delayed treatment in 42%, unnecessary diagnostic cost in 25%, unnecessary exposure to radiation or contrast in 17%, and complications caused by treatments in 4%. The mode of the number of physicians missing the finding was 2, but many oversights were missed by many physicians. Most oversights took up to 5 days to identify, but 66 took longer. Special attention and skill in examining the skin and its appendages, as well as the abdomen, groin, and genitourinary area could reduce the reported oversights by half. CONCLUSIONS Physical examination inadequacies are a preventable source of medical error, and adverse events are caused mostly by failure to perform the relevant examination.
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Affiliation(s)
- Abraham Verghese
- The Program in Bedside Medicine, Stanford University School of Medicine, Stanford, Calif.
| | - Blake Charlton
- Department of Internal Medicine, University of California, San Francisco
| | - Jerome P Kassirer
- Department of Internal Medicine, Tufts University School of Medicine, Boston, Mass
| | - Meghan Ramsey
- The Program in Bedside Medicine, Stanford University School of Medicine, Stanford, Calif
| | - John P A Ioannidis
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif
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Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 PMCID: PMC4618348 DOI: 10.1186/s12909-015-0463-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/25/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
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Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
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Muthaura PN, Khamis T, Ahmed M, Hussain SR. Perceptions of the preparedness of medical graduates for internship responsibilities in district hospitals in Kenya: a qualitative study. BMC MEDICAL EDUCATION 2015; 15:178. [PMID: 26489421 DOI: 10.5539/hes.v3n1p115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 10/12/2015] [Indexed: 05/22/2023]
Abstract
BACKGROUND Aga Khan University is developing its undergraduate medical education curriculum for East Africa. In Kenya, a 1 year internship is mandatory for medical graduates' registration as practitioners. The majority of approved internship training sites are at district hospitals. The purposes of this study were to determine: (1) whether recent Kenyan medical graduates are prepared for their roles as interns in district hospitals upon graduation from medical school; (2) what working and training conditions and social support interns are likely to face in district hospital; and (3) what aspects of the undergraduate curriculum need to be addressed to overcome perceived deficiencies in interns' competencies. METHODS Focus group discussions and semi-structured interviews were conducted with current interns and clinical supervisors in seven district hospitals in Kenya. Perceptions of both interns and supervisors regarding interns' responsibilities and skills, working conditions at district hospitals, and improvements required in medical education were obtained. RESULTS Findings included agreement across informants on deficiencies in interns' practical skills and experience of managing clinical challenges. Supervisors were generally critical regarding interns' competencies, whereas interns were more specific about their weaknesses. Supervisor expectations were higher in relation to surgical procedures than those of interns. There was agreement on the limited learning, clinical facilities and social support available at district hospitals including, according to interns, inadequate supervision. Supervisors felt they provided adequate supervision and that interns lacked the ability to initiate communication with them. Both groups indicated transition challenges from medical school to medical practice attributable to inadequate practical experience. They indicated the need for more direct patient care responsibilities and clinical experience at a district hospital during undergraduate training. CONCLUSION Perception of medical graduates' unpreparedness seemed to stem from a failure to implement the apprenticeship model of learning in medical school and lack of prior exposure to district hospitals. These findings will inform curriculum development to meet stakeholder requirements, improve the quality of graduates, and increase satisfaction with transition to practice.
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Affiliation(s)
| | - Tashmin Khamis
- The Aga Khan University, P.O. Box 30270, GPO 00100, Nairobi, Kenya.
| | - Mushtaq Ahmed
- The Aga Khan University, P.O. Box 38129, Ufukoni Road, Dar es Salaam, Tanzania.
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Owen SJ, Wong K. Cardiac auscultation via simulation: a survey of the approach of UK medical schools. BMC Res Notes 2015; 8:427. [PMID: 26358413 PMCID: PMC4566366 DOI: 10.1186/s13104-015-1419-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2015] [Accepted: 09/07/2015] [Indexed: 11/10/2022] Open
Abstract
Background A decline in clinical skills of medical students and junior doctors is well documented. We aim to determine how the 32 UK medical schools utilise simulated heart sounds to develop medical students’ cardiac auscultation skills. Methods Representatives of all 32 UK medical schools were contacted with a survey questionnaire. Data analysis was carried out using SPSS. Continuous variables e.g. teaching group size were described using median and interquartile range (IQR). Results 27 Medical schools use a form of simulated heart sounds as a teaching method (2 representatives were unsure, 3 did not respond). This teaching is mandatory in 17 schools. Simulation-based teaching tends to be offered during 3rd year of medical training [median = 3rd year, interquartile range (IQR) 2–3]. Seven medical schools offered simulation teaching more than once. The median number of students in each session was 7.5 [IQR = 5.5–9.5]. One medical school reported that they were unsure how best to implement the heart sound simulation into the medical undergraduate curriculum. Conclusion The results of our survey of all the UK medical schools suggest that heart sound simulation are used mainly as an introduction to heart murmurs rather than a tool for repetitive practice, complementing clinical experience. Most medical schools do not measure the impact of such teaching on clinical examination.
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Affiliation(s)
- Samantha Jayne Owen
- Hull York Medical School, John Hughlings Jackson Building, Heslington, York, YO10 5DD, UK.
| | - Kenneth Wong
- Department of Academic Cardiology, Hull York Medical School, Castle Hill Hospital, Castle Rd, Cottingham, Hull, HU16 5JQ, UK.
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Martinez J, Harris C, Jalali C, Tung J, Meyer R. Using peer-assisted learning to teach and evaluate residents' musculoskeletal skills. MEDICAL EDUCATION ONLINE 2015; 20:27255. [PMID: 26028495 PMCID: PMC4450246 DOI: 10.3402/meo.v20.27255] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Revised: 04/16/2015] [Accepted: 04/20/2015] [Indexed: 05/29/2023]
Abstract
Although direct observation and corrective feedback are established methods of increasing select aspects of residents' musculoskeletal (MSK) clinical skills, the evaluation and management of patients with MSK complaints remains an underemphasized part of internal medicine training. This paper reports on the development of an innovative peer-assisted learning (PAL) model to teach five MSK areas (back, knee, shoulder, neck, or hip pain). Based on data from 42 participating interns and 44 senior residents from an urban US academic medical center, results from an objective structured clinical exam (OSCE) demonstrate gains in both knowledge and self-reported confidence in MSK skills. Moreover, subsequent focus group results reveal a strong preference for the PAL model. In conclusion, an educational module that utilizes the OSCE format holds much promise for teaching MSK skills to both intern and senior residents.
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Affiliation(s)
- Johanna Martinez
- New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA;
| | - Christina Harris
- VA Greater Los Angeles Healthcare System, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Cathy Jalali
- New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Judy Tung
- New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
| | - Robert Meyer
- New York Presbyterian-Weill Cornell Medical Center, New York, NY, USA
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Weitz G, Vinzentius C, Twesten C, Lehnert H, Bonnemeier H, König IR. Effects of a rater training on rating accuracy in a physical examination skills assessment. GMS ZEITSCHRIFT FUR MEDIZINISCHE AUSBILDUNG 2014; 31:Doc41. [PMID: 25489341 PMCID: PMC4259060 DOI: 10.3205/zma000933] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/08/2014] [Revised: 03/24/2014] [Accepted: 08/20/2014] [Indexed: 11/30/2022]
Abstract
Background: The accuracy and reproducibility of medical skills assessment is generally low. Rater training has little or no effect. Our knowledge in this field, however, relies on studies involving video ratings of overall clinical performances. We hypothesised that a rater training focussing on the frame of reference could improve accuracy in grading the curricular assessment of a highly standardised physical head-to-toe examination. Methods: Twenty-one raters assessed the performance of 242 third-year medical students. Eleven raters had been randomly assigned to undergo a brief frame-of-reference training a few days before the assessment. 218 encounters were successfully recorded on video and re-assessed independently by three additional observers. Accuracy was defined as the concordance between the raters' grade and the median of the observers' grade. After the assessment, both students and raters filled in a questionnaire about their views on the assessment. Results: Rater training did not have a measurable influence on accuracy. However, trained raters rated significantly more stringently than untrained raters, and their overall stringency was closer to the stringency of the observers. The questionnaire indicated a higher awareness of the halo effect in the trained raters group. Although the self-assessment of the students mirrored the assessment of the raters in both groups, the students assessed by trained raters felt more discontent with their grade. Conclusions: While training had some marginal effects, it failed to have an impact on the individual accuracy. These results in real-life encounters are consistent with previous studies on rater training using video assessments of clinical performances. The high degree of standardisation in this study was not suitable to harmonize the trained raters’ grading. The data support the notion that the process of appraising medical performance is highly individual. A frame-of-reference training as applied does not effectively adjust the physicians' judgement on medical students in real-live assessments.
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Affiliation(s)
- Gunther Weitz
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik I, Lübeck, Deutschland
| | - Christian Vinzentius
- Institut für Qualitätsentwicklung an Schulen Schleswig-Holstein, Kronshagen, Deutschland
| | - Christoph Twesten
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik I, Lübeck, Deutschland
| | - Hendrik Lehnert
- Universitätsklinikum Schleswig-Holstein, Campus Lübeck, Medizinische Klinik I, Lübeck, Deutschland
| | - Hendrik Bonnemeier
- Universitätsklinikum Schlesweig-Holstein, Campus Kiel, Medizinische Klinik III, Kiel, Deutschland
| | - Inke R König
- Universität zu Lübeck, Institut für Medizinische Biometrie und Statistik, Lübeck, Deutschland
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Affiliation(s)
- Jecko Thachil
- Consultant Haematologist in the Department of Haematology, Manchester Royal Infirmary, Manchester M13 9WL
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Ramani S. Patient-centered care or patient data-centered care: a tale of 2 admissions. J Grad Med Educ 2013; 5:362-4. [PMID: 24404296 PMCID: PMC3771162 DOI: 10.4300/jgme-d-12-00283.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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Abstract
OBJECTIVES There is widespread recognition that physical examination (PE) should be taught in Graduate Medical Education (GME), but little is known regarding how to best teach PE to residents. Deliberate practice fosters expertise in other fields, but its utility in teaching PE is unknown. We systematically reviewed the literature to determine the effectiveness of methods to teach PE in GME, with attention to usage of deliberate practice. DATA SOURCES We searched PubMed, ERIC, and EMBASE for English language studies regarding PE education in GME published between January 1951 and December 2012. STUDY ELIGIBILITY CRITERIA Seven eligibility criteria were applied to studies of PE education: (1) English language; (2) subjects in GME; (3) description of study population; (4) description of intervention; (5) assessment of efficacy; (6) inclusion of control group; and (7) report of data analysis. STUDY APPRAISAL AND SYNTHESIS METHODS We extracted data regarding study quality, type of PE, study population, curricular features, use of deliberate practice, outcomes and assessment methods. Tabulated summaries of studies were reviewed for narrative synthesis. RESULTS Fourteen studies met inclusion criteria. The mean Medical Education Research Study Quality Instrument (MERSQI) score was 9.0 out of 18. Most studies (n = 8) included internal medicine residents. Half of the studies used resident interaction with a human examinee as the primary means of teaching PE. Three studies "definitely" and four studies "possibly" used deliberate practice; all but one of these studies demonstrated improved educational outcomes. LIMITATIONS We used a non-validated deliberate practice assessment. Given the heterogeneity of assessment modalities, we did not perform a meta-analysis. CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS No single strategy for teaching PE in GME is clearly superior to another. Following the principles of deliberate practice and interaction with human examinees may be beneficial in teaching PE; controlled studies including these educational features should be performed to investigate these exploratory findings.
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Myer CA, Hegedus EJ, Tarara DT, Myer DM. A user's guide to performance of the best shoulder physical examination tests. Br J Sports Med 2013; 47:903-7. [DOI: 10.1136/bjsports-2012-091870] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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