Abstract
BackgroundPhysicians 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.MethodsOne 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).ResultsInterns 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.ConclusionsA 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.
Highlights
Introduction to the Pulmonary ExamReview of basic skills on a healthy volunteer or inpatient.3
All interns were invited to participate in Advancing Bedside Cardiopulmonary Examination Skills (ACE), including 53 from July 2015– June 2016, and 52 from July 2016–June 2017. 81.1% were in the categorical program, with the remainder in preliminary, primary care or combined medicinepediatrics programs
Interns and Post-graduate year 2 (PGY-2) “strongly agreed” that the cardiopulmonary exam is an important part of patient assessment and that improving exam skills is an important goal for the year of training
Summary
Introduction to the Pulmonary ExamReview of basic skills on a healthy volunteer or inpatient.3. 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. In addition to its enduring importance in patient care, the physical exam is a ritual which plays an integral role in developing a meaningful and therapeutic relationship with a patient [25, 26] This relationship is threatened by less time and lack of emphasis on the bedside encounter [10]
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