Examination In Internal Medicine Research Articles

ChatGPT fails the Polish board certification examination in internal medicine: artificial intelligence still has much to learn.

ChatGPT fails the Polish board certification examination in internal medicine: artificial intelligence still has much to learn.

Medical Students' Performances Using Different Assessment Methods during the Final Examination in Internal Medicine at the University of Benghazi, Libya

Background Distinctive evaluation tools assess diverse fields of learning that considerably impact the learning process. Objective To compare and correlate the performances of undergraduate final year medical students in written, clinical, and viva examinations in the subject of internal medicine. Methods This is a retrospective study. After authority approval, data was collected from final year examination results during 2019 to 2020. All the students of the medical school at University of Benghazi were included in this study. Their gender and their written, clinical, viva, and total scores were included. Data were coded and transferred from Excel to SPSS version 24 and expressed as frequencies and percentages. Chi-squared analysis was performed to test for differences in the proportions of categorical variables between two or more groups. Odd ratio (OR) is used to calculate the odds of passing the subject based on scores in different types of exams. Person's correlation (R) is used to evaluate the consistency of students' performances in different examinations. A p-value of less than 0.05 was considered the cut-off value of significant. Results The total number of students was 679, out of which 499 (73.5%) were females and 180 (26.5%) were males. The total number of students who passed the course was 422 (62%) with no significant differences between males and females. A statistically significant (p < 0.001) greater percentage of students achieved a passing score in clinical assessment (502 [73.9%]), followed by viva assessment (458.0 [67.5%]). The students performed the worse in written examination with only 291/679 (43%) students passing the examination, with no gender-based differences. There was a highly significant association between the total score of students who passed the subject and their scores in the written examination with an OR of 2.3 (p < 0.001). Viva examination and total score OR was 0.79 with no significant differences for males or females. On the contrary, there was a statistically significant negative association between clinical exams and total scores of students who passed the subject (OR = 0.58). There was a highly significant correlation (p < 0.001) between written examination and viva examination (R = 0.638), between written examination and clinical examination (R = 0.629), and between clinical and viva examinations (R = 0.763). Conclusion Students demonstrated higher performance on clinical and viva exams compared with written exams. Additionally, there were no notable disparities in results between male and female students across any of the three exam types. The written exam served as the most reliable indicator of a student's success in the subject. Furthermore, the data revealed a positive correlation between scores on the different exam formats, indicating that students exhibited consistent performance across all modes of evaluation.

Item format statistics and readability of extended matching questions as an effective tool to assess medical students

Testing based on multiple choice questions (MCQ) is one of the most established forms of assessment, not only in the medical field. Extended matching questions (EMQ) represent a specific type of MCQ designed to require higher levels of cognition, such as problem-solving. The purpose of this evaluation was to assess the suitability and efficiency of EMQ as an assessment method. EMQ were incorporated into the end-of-semester examination in internal medicine, in which 154 students participated, and compared with three established MCQ types. Item and examination quality were investigated, as well as readability and processing time. EMQ were slightly more difficult to score; however, both item discrimination and discrimination index were higher when compared to other item types. EMQ were found to be significantly longer and required more processing time, but readability was improved. Students judged EMQ as clearly challenging, but attributed significantly higher clinical relevance when compared to established MCQ formats. Using the Spearman-Brown prediction, only ten EMQ items would be needed to reproduce the Cronbach’s alpha value of 0.75 attained for the overall examination. EMQ proved to be both efficient and suitable when assessing medical students, demonstrating powerful characteristics of reliability. Their expanded use in favor of common MCQ could save examination time without losing out on statistical quality.

Abdominal Ultrasound Education for Gastroenterology Residents and Fellows

Ultrasound (US) is an essential diagnostic tool in almost every medical area. Therefore, abdominal US education for internal medicine residents was mandated by the Korean Association of Internal Medicine. However, US education for physicians has been conducted only in some university hospitals that directly perform abdominal US examinations in internal medicine, or some education is provided with the help of radiologists. US technology continues to become increasingly widespread, portable, and miniaturized. Furthermore, point-of-care US, i.e., US executed at the patient's bedside to obtain real-time objective information with diagnostic and clinical monitoring purposes or to guide invasive procedures, has been incorporated in many specialties. Despite the increasing role of US, there is no systemized abdominal US education program. Therefore, the authors are trying to develop a structured abdominal US education program through cooperation with related US organizations.

Score Gains on the NBME Subject Examinations in Internal Medicine Among Clerkship Students: a Two-Year Longitudinal Study from the United Arab Emirates.

The impact of clinical proficiency on individual student scores on the National Board of Medical Examiners (NBME) Subject Examinations remains uncertain. We hypothesised that increasing the length of time spent in a clinical environment would augment students' performance. Performance on the NBME Subject Examination in Internal Medicine (NBME-IM) of three student cohorts was observed longitudinally. Scores at the end of two unique internal medicine clerkships held at the third and fourth years were compared. The score differences between the two administrations were compared using paired t-tests, and the effect size was measured using Cohen's d. Moreover, linear regression was used to assess the correlation between the NBME-IM score gains and performance on a pre-clinical Comprehensive Basic Science Examination (CBSE). A two-tailed p-value <0.05 was considered significant. Of the 236 students enrolled during the third year, age, gender, CBSE, and NBME-IM scores were similar across all cohorts. The normalised score gain on the NBME-IM at the fourth year was 9.5% (range -38 to +45%) with a Cohen's d of 0.47. However, a larger effect size with a Cohen's d value of 0.96 was observed among poorly scoring students. Performance on the CBSE was a significant predictor of score gain on the NBME-IM (R 0.51, R 2 0.26, p-value < 0.001). Despite the increased length of clinical exposure, modest improvement in students' performance on repeated NBME-IM examination was observed. Medical educators need to reconsider how the NBME-IM is used in clerkship assessments.

The specialist examination in internal medicine: a qualitative andquantitative analysis of minutes from memory

The specialist examination entitles to independent professional conduct and is therefore of great significance for the quality of medical care. It should cover the contents of the continuing education regulations. So far, little is known about the actual content of the exam. In this study, the question was, which content and which structural characteristics do specialist examinations in internal medicine in Germany contain. 100 randomly selected protocols from nationwide specialist examinations from the years 2013-2016 were quantitatively recorded and descriptively evaluated with regards to their main content as well as the various types of questions. The results were compared with the blueprints of the medical examinations in Switzerland and the USA. In each exam, an average of 27 (SD = 10) questions are asked. The questions can be categorized into three categories: (1) subject-specific questions, (2) case-related questions, and (3) diagnostic-oriented questions with visual material. Cardiology and Gastroenterology, each with 17 %, and Endocrinology with 11 % are the most frequently requested internal medical topics. For 50 % of the questions, the examinee must reproduce knowledge, while for the other 50 %, concepts and procedures must be understood and used. In comparison with the American and Swiss blueprints, a similar percentual distribution of question contents was found. With regards to the American blueprint, it is noticeable that there are more questions from other specialist areas such as Urology, Neurology and Psychiatry in comparison to Germany. The Swiss blueprint covers a wide range of interdisciplinary aspects such as ethics, prevention and economics which are not subject to examination in the German specialist examination. In the oral specialist examination in internal medicine in Germany as many topics as in foreign specialist examinations are examined. However, the variance between the individual exams is relatively large. A standardization of the exam is important to create equal exam conditions for all candidates.

Epidermal Fatty Acid-Binding Protein: A Novel Marker in the Diagnosis of Dry Eye Disease in Sjögren Syndrome.

Purpose: Sjögren syndrome (SS) is a chronic inflammatory autoimmune disease of the lacrimal and salivary glands. This study compared the concentrations of epidermal fatty-acid binding protein (E-FABP) in the saliva, serum, and tears of SS patients with dry eye and dry mouth, with those of healthy adults to investigate the usefulness of E-FABP as a diagnostic marker for SS. Design: Prospective, observational case series. Participants: The subjects were 11 new patients with untreated Sjogren syndrome and 12 healthy control individuals. Methods: The diagnosis of SS was in accordance with the Ministry of Health, Labour and Welfare (Japan) Diagnostic Criteria (1999). Saliva, serum, and tear specimens were collected during internal medicine, dental, and ophthalmological examinations. The ophthalmological tests included the Dry Eye-related Quality of life Score (DEQS), tear break-up time (BUT), vital staining with fluorescein (FS) and lissamine green (LG), and the Schirmer test-1. The E-FABP concentration in the tears, saliva, and serum was measured by enzyme-linked immunosorbent assay (ELISA). Main outcome measure: The E-FABP concentrations were compared between patients and controls. Results: There were significant differences between the patient and healthy control groups in all ophthalmological test results. There were no significant differences between the groups in the E-FABP concentrations in the saliva (p = 0.1513) or the serum (p = 0.4799), but the E-FABP concentration in the tears significantly differed between groups. The E-FABP concentration in tears tended to be significantly lower in patients with SS (mean, 323.5 ± 325.6 pg/mL) than healthy control subjects (mean, 4076 pg/mL; p = 0.0136). The E-FABP concentration in tears significantly correlated with the results of dry eye parameters. Conclusion: The E-FABP concentration in tears appears to be related to ocular surface epithelial damage and tear stability and may be a promising novel biomarker in the diagnosis of SS.

Using differential item functioning to evaluate potential bias in a high stakes postgraduate knowledge based assessment

BackgroundFairness is a critical component of defensible assessment. Candidates should perform according to ability without influence from background characteristics such as ethnicity or sex. However, performance differs by candidate background in many assessment environments. Many potential causes of such differences exist, and examinations must be routinely analysed to ensure they do not present inappropriate progression barriers for any candidate group. By analysing the individual questions of an examination through techniques such as Differential Item Functioning (DIF), we can test whether a subset of unfair questions explains group-level differences. Such items can then be revised or removed.MethodsWe used DIF to investigate fairness for 13,694 candidates sitting a major international summative postgraduate examination in internal medicine. We compared (a) ethnically white UK graduates against ethnically non-white UK graduates and (b) male UK graduates against female UK graduates. DIF was used to test 2773 questions across 14 sittings.ResultsAcross 2773 questions eight (0.29%) showed notable DIF after correcting for multiple comparisons: seven medium effects and one large effect. Blinded analysis of these questions by a panel of clinician assessors identified no plausible explanations for the differences. These questions were removed from the question bank and we present them here to share knowledge of questions with DIF. These questions did not significantly impact the overall performance of the cohort. Group-level differences in performance between the groups we studied in this examination cannot be explained by a subset of unfair questions.ConclusionsDIF helps explore fairness in assessment at the question level. This is especially important in high-stakes assessment where a small number of unfair questions may adversely impact the passing rates of some groups. However, very few questions exhibited notable DIF so differences in passing rates for the groups we studied cannot be explained by unfairness at the question level.

Comparison of Content on the American Board of Internal Medicine Maintenance of Certification Examination With Conditions Seen in Practice by General Internists

Success on the internal medicine (IM) examination is a central requirement of the American Board of Internal Medicine's (ABIM's) Maintenance of Certification program (MOC). Therefore, it is important to understand the degree to which this examination reflects conditions seen in practice, one dimension of content validity, which focuses on the match between content in the discipline and the topics on the examination questions. To assess whether the frequency of questions on IM-MOC examinations were concordant with the frequency of conditions seen in practice. The 2010-2013 IM-MOC examinations were used to calculate the percentage of questions for 186 medical condition categories from the examination blueprint, which balances examination content by considering importance and frequency of conditions seen in practice. Nationally representative estimates of conditions seen in practice by general internists were estimated from the primary diagnosis for 13 832 office visits (2010-2013 National Ambulatory Medical Care Surveys) and 108 472 hospital stays (2010 National Hospital Discharge Survey). Prevalence of conditions included on the IM-MOC examination questions. The outcome measure was the concordance between the percentages of IM-MOC examination questions and the percentages of conditions seen in practice during either office visits or hospital stays for each of 186 condition categories (eg, diabetes mellitus, ischemic heart disease, liver disease). The concordance thresholds were 0.5 SD of the weighted mean percentages of the applicable 186 conditions seen in practice (0.74% for office visits; 0.51% for hospital stays). If the absolute differences between the percentages of examination questions and the percentages of office visit conditions or hospital stay conditions seen were less than the applicable concordance threshold, then the condition category was judged to be concordant. During the 2010-2013 IM-MOC examination periods, 3600 questions (180 questions per examination form) were administered and 3461 questions (96.1%) were mapped into the 186 study conditions (mean, 18.6 questions per condition). Comparison of the percentages of 186 categories of medical conditions seen in 13 832 office visits and 108 472 hospital stays with the percentages of 3461 questions on IM-MOC examinations revealed that 2389 examination questions (69.0%; 95% CI, 67.5%-70.6% involving 158 conditions) were categorized as concordant. For concordance between questions and office visits only, 2010 questions (58.08%; 95% CI, 56.43%-59.72% of all examination questions) involving 145 conditions were categorized as concordant. For concordance between questions and hospital stays only, 1456 questions (42.07%; 95% CI, 40.42%-43.71% of all examination questions) involving 122 conditions were categorized as concordant. Among questions on IM-MOC examinations from 2010-2013, 69% were concordant with conditions seen in general internal medicine practices, although some areas of discordance were identified.

FAMULATUR PLUS - A successful model for improving students' physical examination skills?

Introduction/Project description: Several studies have revealed insufficient physical examination skills among medical students, both with regard to the completeness of the physical examination and the accuracy of the techniques used. FAMULATUR PLUS was developed in response to these findings. As part of this practice-oriented instructional intervention, physical examination skills should be taught through examination seminars and problem-oriented learning approaches. In order to ensure practical relevance, all courses are integrated into a 30-day clinical traineeship in the surgery or internal medicine department of a hospital (FAMULATUR PLUS).Research question: Does participation in the FAMULATUR PLUS project lead to a more optimistic self-assessment of examination skills and/or improved performance of the physical examination?Methodology: A total of 49 medical students participated in the study. The inclusion criteria were as follows: enrollment in the clinical studies element of their degree program at the University of Ulm and completion of the university course in internal medicine examinations. Based on their personal preferences, students were assigned to either the intervention (surgery/internal medicine; n=24) or the control group (internal medicine; n=25). All students completed a self-assessment of their physical examination skills in the form of a questionnaire. However, practical examination skills were only assessed in the students in the intervention group. These students were asked to carry out a general physical examination of the simulation patient, which was recorded and evaluated in a standardized manner. In both instances, data collection was carried out prior to and after the intervention. Results: The scores arising from the student self-assessment in the intervention (IG) and control groups (CG) improves significantly in the pre-post comparison, with average scores increasing from 3.83 (±0.72; IG) and 3.54 (±0.37; CG) to 1.92 (±0.65; IG) and 3.23 (±0.73; CG). The general physical examination, which was only assessed among the students in the intervention group, was performed more completely after the instructional intervention than prior to it.Discussion: On the basis of the data collected, it can be deduced that the FAMULATUR PLUS course has a positive effect on the self-assessment of medical students with regard to their physical examination skills. The validity of this conclusion is limited by the small sample size. In addition, it remains unclear whether a more positive self-assessment correlates with an objective improvement in physical examination skills.

Enhancing Internal Medicine Residents’ Royal College Exam Competency Using In-Training Written Exams within a Competency Based Medical Education Framework

Enhancing Internal Medicine Residents’ Royal College Exam Competency Using In-Training Written Exams within a Competency Based Medical Education Framework

Atypical Anterior Optic Neuritis Resembles Anterior Ischemic Optic Neuropathy : A Unique Case Report

&#x0D; &#x0D; &#x0D; Purpose : We present a unique case of atypical anterior optic neuritis resemble anterior ischemic optic neuropathy Methods : This was a single case study, with a patient was followed up for 2 months. Visual acuity, visual field, color vision, intraocular pressure, and ocular anatomy, were examined. &#x0D; Results : A female patient 54 y/o with chief complain sudden blurred vision on both eyes after woke up in the morning without redness and tearing 4 days before day of visit. History of systemic and ocular diseases were denied. Visual acuity was 0.5/60 (superior) right eye and 1/60 (superior) left eye, couldn’t be corrected. Relative afferent pupillary defect was observed in right eye. Biomicroscopic examination of anterior segment and intraocular pressures were normal. Funduscopy revealed ill defined margin at optic nerve head for both eyes suggested papilledema. At the present we couldn’t examined color vision. Visual field examination showed inferior altitudinal defect (more severe in right eye). Consultation to internal medicine and laboratory examination such as: complete blood count, lipid profile, blood glucose, and electrocardiogram were done to confirm our diagnosis. Clinically, the diagnosis of the disease more likely to be the anterior optic neuritis. Follow-up after 2 months has normal visual acuity, visual field, and color perception after steroid treatment. &#x0D; Conclusion : Anterior optic neuritis might have a very similar clinical presentation of anterior ischemic optic neuropathy upon early manifestation. &#x0D; &#x0D; &#x0D;

Response to: Is it time to rethink the MCCQE Part II?

Response to: Is it time to rethink the MCCQE Part II?

Do OSCE progress test scores predict performance in a national high-stakes examination?

Progress tests, in which learners are repeatedly assessed on equivalent content at different times in their training and provided with feedback, would seem to lend themselves well to a competency-based framework, which requires more frequent formative assessments. The objective structured clinical examination (OSCE) progress test is a relatively new form of assessment that is used to assess the progression of clinical skills. The purpose of this study was to establish further evidence for the use of an OSCE progress test by demonstrating an association between scores from this assessment method and those from a national high-stakes examination. The results of 8 years' of data from an Internal Medicine Residency OSCE (IM-OSCE) progress test were compared with scores on the Royal College of Physicians and Surgeons of Canada Comprehensive Objective Examination in Internal Medicine (RCPSC IM examination), which is comprised of both a written and performance-based component (n = 180). Correlations between scores in the two examinations were calculated. Logistic regression analyses were performed comparing IM-OSCE progress test scores with an 'elevated risk of failure' on either component of the RCPSC IM examination. Correlations between scores from the IM-OSCE (for PGY-1 residents to PGY-4 residents) and those from the RCPSC IM examination ranged from 0.316 (p = 0.001) to 0.554 (<.001) for the performance-based component and 0.305 (p = 0.002) to 0.516 (p < 0.001) for the written component. Logistic regression models demonstrated that PGY-2 and PGY-4 scores from the IM-OSCE were predictive of an 'elevated risk of failure' on both components of the RCPSC IM examination. This study provides further evidence for the use of OSCE progress testing by demonstrating a correlation between scores from an OSCE progress test and a national high-stakes examination. Furthermore, there is evidence that OSCE progress test scores are predictive of future performance on a national high-stakes examination.

US Medical Student Performance on the NBME Subject Examination in Internal Medicine: Do Clerkship Sequence and Clerkship Length Matter?

Prior to graduation, US medical students are required to complete clinical clerkship rotations, most commonly in the specialty areas of family medicine, internal medicine, obstetrics and gynecology (ob/gyn), pediatrics, psychiatry, and surgery. Within a school, the sequence in which students complete these clerkships varies. In addition, the length of these rotations varies, both within a school for different clerkships and between schools for the same clerkship. The present study investigated the effects of clerkship sequence and length on performance on the National Board of Medical Examiner's subject examination in internal medicine. The study sample included 16,091 students from 67 US Liaison Committee on Medical Education (LCME)-accredited medical schools who graduated in 2012 or 2013. Student-level measures included first-attempt internal medicine subject examination scores, first-attempt USMLE Step 1 scores, and five dichotomous variables capturing whether or not students completed rotations in family medicine, ob/gyn, pediatrics, psychiatry, and surgery prior to taking the internal medicine rotation. School-level measures included clerkship length and average Step 1 score. Multilevel models with students nested in schools were estimated with internal medicine subject examination scores as the dependent measure. Step 1 scores and the five dichotomous variables were treated as student-level predictors. Internal medicine clerkship length and average Step 1 score were used to predict school-to-school variation in average internal medicine subject examination scores. Completion of rotations in surgery, pediatrics and family medicine prior to taking the internal medicine examination significantly improved scores, with the largest benefit observed for surgery (coefficient = 1.58 points; p value < 0.01); completion of rotations in ob/gyn and psychiatry were unrelated to internal medicine subject examination performance. At the school level, longer internal medicine clerkships were associated with higher scores on the internal medicine examination (coefficient = 0.23 points/week; p value < 0.01). The order in which students complete clinical clerkships and the length of the internal medicine clerkship are associated with their internal medicine subject examination scores. Findings may have implications for curriculum re-design.

Editorial introductions

Editorial introductions

A phenomenographic study of students' conception of learning for a written examination.

ObjectivesWe investigated students' conception of learning for an examination in internal medicine, infectious diseases and dermatology-venereology, in three separate examinations versus a single integrated one. MethodsThe study was carried out during a curricular change, with one cohort belonging to a new integrated examination and the other to the former non-integrated examination. Forty-eight interviews were carried out among medical undergraduates regarding the role of the examination in the learning process. The interviews were analyzed according to the phenomenographic approach to identify the students' conception of learning. ResultsThe learning approaches could be categorized in 47 of the 48 students into 4 major groups: application directed, holistic, comprehensive and tactical memorizing learning. The result indicated that comprehensive learning was the most common approach among students following either examination-form; tactical memorizing learning was more prevalent among students following the non-integrated examination and holistic learning was applied more frequently among students following the integrated examination. Nine of the 47 students changed their approaches over time, the majority switching to a compre-hensive approach. No significant gender difference was observed. ConclusionsComprehensive learning was the most common strategy employed and students who changed during the course most often switched to this. However, only a minor change in approach was observed after a switching to an integrated examination, i.e. it takes more than just an integrated examination to change the stu-dent's conception of learning.

Use of MKSAP 16 for American Board of Internal Medicine Examination.

In reviewing MKSAP 16 in preparation for an American Board of Internal Medicine recertification examination, Dr. Melissa Gennarelli, an internist at Westchester Medical Center/New York Medical College, asked Dr. Wilbert S. Aronow, a Professor of Cardiology at Westchester Medical Center/New York Medical College, 2 questions. The first question was why he currently recommends that diabetics with hypertension should have their systolic blood pressure reduced to < 140 mm Hg when MKSAP 16 (page 29 of Cardiovascular Medicine) recommends a systolic blood pressure goal of < 130 mm Hg. The second question was why he does not use dronedarone to treat high-risk patients with permanent atrial fibrillation when MKSAP 16 (page 52 of Cardiovascular Medicine) recommends the use of dronedarone in patients with atrial fibrillation to reduce hospitalization for cardiovascular events or mortality. In reply to the first question, Dr. Aronow stated that on the basis of clinical trial data, the 2009 European Society of Hypertension guidelines [1], the American College of Cardiology Foundation/American Heart Association 2011 expert consensus document on hypertension in the elderly [2], and an excellent review article on this topic [3] recommend a systolic blood pressure goal of <140 mm Hg in diabetics with hypertension. The 2013 American Diabetes Association guidelines recommend a systolic blood pressure goal of < 140 mm Hg in most diabetics with hypertension [4]. In reply to the second question, Dr. Aronow stated that the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS) randomized 3,236 patients with permanent atrial fibrillation and risk factors for major vascular events to treatment with dronedarone or double-blind placebo [5]. This study was stopped for safety reasons with a median follow-up of 3.5 months because dronedarone increased the rates of heart failure, stroke, and cardiovascular mortality in patients with permanent atrial fibrillation at risk for major vascular events [5].

Creating a longitudinal integrated clerkship with mutual benefits for an academic medical center and a community health system.

The longitudinal integrated clerkship is a model of clinical education driven by tenets of social cognitive theory, situated learning, and workplace learning theories, and built on a foundation of continuity between students, patients, clinicians, and a system of care. Principles and goals of this type of clerkship are aligned with primary care principles, including patient-centered care and systems-based practice. Academic medical centers can partner with community health systems around a longitudinal integrated clerkship to provide mutual benefits for both organizations, creating a sustainable model of clinical training that addresses medical education and community health needs. A successful one-year longitudinal integrated clerkship was created in partnership between an academic medical center and an integrated community health system. Compared with traditional clerkship students, students in this clerkship had better scores on Clinical Performance Examinations, internal medicine examinations, and high perceptions of direct observation of clinical skills.Advantages for the academic medical center include mitigating the resources required to run a longitudinal integrated clerkship while providing primary care training and addressing core competencies such as systems-based practice, practice-based learning, and interprofessional care. Advantages for the community health system include faculty development, academic appointments, professional satisfaction, and recruitment.Success factors include continued support and investment from both organizations' leadership, high-quality faculty development, incentives for community-based physician educators, and emphasis on the mutually beneficial relationship for both organizations. Development of a longitudinal integrated clerkship in a community health system can serve as a model for developing and expanding these clerkship options for academic medical centers.

Student performance of the general physical examination in internal medicine: an observational study

BackgroundMany practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine.MethodsOne hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items.ResultsApproximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001).ConclusionsIn conclusion, performance of the general physical examination was already below expectation at the end of the internal medicine clerkship. Possible causes and suggestions for improvement are discussed.