How do novices learn physical examination skills? A systematic review of the literature

Aaron R Danielson,Sandhya Venugopal,Jason M Mefford,Samuel O Clarke

doi:10.1080/10872981.2019.1608142

Abstract

ABSTRACTBackground: Physical Examination (PE) skills are vital for patient care, and many medical students receive their first introduction to them in their pre-clinical years. A substantial amount of curriculum time is devoted to teaching these skills in most schools. Little is known about the best way to introduce PE skills to novice learners.Objective: Our objective was to conduct a systematic review of how medical students are first taught PE skills and the evidence supporting these strategies.Design: We searched ERIC, SCOPUS, MEDLINE, PubMed and EMBASE for descriptions of complete PE curricula for novice learners. Inclusion criteria were: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) Description of a complete PE curriculum. We used the Medical Education Research Study Quality Instrument (MERSQI) score to evaluate the quality of evidence provided.Results: Our search returned 5,418 articles; 32 articles met our inclusion criteria. Two main types of curricula were reported: comprehensive ‘head-to-toe’ PE curricula (18%) and organ system-based curricula (41%). No studies compared these directly, and only two evaluated trainees’ clinical performance. The rest of the articles described interventions used across curricula (41%). Median MERSQI score was 10.1 Interquartile range 8.1–12.4. We found evidence for the use of non-faculty teaching associates, technology-enhanced PE education, and the addition of clinical exposure to formal PE teaching.Conclusions: The current literature on teaching PE is focused on describing innovations to head-to-toe and organ system-based curricula rather than their relative effectiveness, and is further limited by its reliance on short-term outcomes. The optimal strategy for novice PE instruction remains unknown.

Highlights

Introduction of an Objective Structured Clinical Examination (OSCE) and learnerThe Curriculum organ system attitudes was well liked.Implementation examination of the curriculum where curriculum each organ resulted in system is taught a statistical by a clinical improvement in department.physical exam performance.Rogers 2001 USA Stillman 1979 USA Stillman 1981 USA Stillman 1997 China11 MS1 ExperimentalTwo group, non- Movement of clinical OSCEMS-1 students and707, randomized, skills curriculum showedMS2 control: 596 non-concurrent from second year statistically to first year.better performance.13 MS1 Experimental
They are considered a core patient care competency as defined by the Accreditation Council for Graduate Medical Education, as well as the newer entrustable professional activities (EPAs) for medical students described by Chen et al [1,2]
We evaluated each study for inclusion based on the following criteria: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) description of a curriculum that teaches a complete Physical Examination (PE)

Summary

Introduction

Introduction of an OSCE and learnerThe Curriculum organ system attitudes was well liked.Implementation examination of the curriculum where curriculum each organ resulted in system is taught a statistical by a clinical improvement in department.physical exam performance.Rogers 2001 USA Stillman 1979 USA Stillman 1981 USA Stillman 1997 China11 MS1 ExperimentalTwo group, non- Movement of clinical OSCEMS-1 students and707, randomized, skills curriculum showedMS2 control: 596 non-concurrent from second year statistically to first year.better performance.13 MS1 Experimental. Physical Examination (PE) skills are vital for patient care, and many medical students receive their first introduction to them in their pre-clinical years. Inclusion criteria were: (1) English language; (2) subjects were enrolled in medical school and were in the preclinical portion of their training; (3) description of a method to teach physical examination skills for the first time; (4) description of the study population; (5) Description of a complete PE curriculum. Physical examination (PE) skills are essential to the practice of clinical medicine They are considered a core patient care competency as defined by the Accreditation Council for Graduate Medical Education, as well as the newer entrustable professional activities (EPAs) for medical students described by Chen et al [1,2]. A systematic review of the literature describing approaches to teaching PE skills to novice medical students is currently lacking

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