Background: 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.
Designing and evaluating health professions educational programs require a range of skills in a rapidly changing educational and healthcare environment. Not all program directors possess all the required leadership skills. In this twelve tips article, we describe a systematic approach to effectively address the complexity facing program leadership, implement robust programs and meaningfully evaluate their impact. They also offer a roadmap for managing diverse stakeholders with often competing demands. The tips are categorized under three domains: Planning, Initial Implementation, and Monitoring. Specific recommendations are provided on addressing context, organizational culture, and key relationships along with practical techniques adapted from continuous quality improvement programs. An outcomes-based approach ensures that program leaders balance competing demands. The tips provide a structure for educational leaders worldwide to reflect on what is feasible in their own context, understand and address complexities in program design and evaluation, regardless of the resources at their disposal.
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