IMPORTANCE General health checks, also known as general medical examinations, periodic health evaluations, checkups, routine visits, or wellness visits, are commonly performed in adult primary care to identify and prevent disease. Although general health checks are often expected and advocated by patients, clinicians, insurers, and health systems, others question their value.OBSERVATIONS Randomized trials and observational studies with control groups reported in prior systematic reviews and an updated literature review through March 2021 were included. Among 19 randomized trials (906 to 59 616 participants; follow-up, 1 to 30 years), 5 evaluated a single general health check, 7 evaluated annual health checks, 1 evaluated biannual checks, and 6 evaluated health checks delivered at other frequencies. Twelve of 13 observational studies (240 to 471 415 participants; follow-up, cross-sectional to 5 years) evaluated a single general health check. General health checks were generally not associated with decreased mortality, cardiovascular events, or cardiovascular disease incidence. For example, in the South-East London Screening Study (n = 7229), adults aged 40 to 64 years who were invited to 2 health checks over 2 years, compared with adults not invited to screening, experienced no 8-year mortality benefit (6% vs 5%). General health checks were associated with increased detection of chronic diseases, such as depression and hypertension; moderate improvements in controlling risk factors, such as blood pressure and cholesterol; increased clinical preventive service uptake, such as colorectal and cervical cancer screening; and improvements in patient-reported outcomes, such as quality of life and self-rated health. In the Danish Check-In Study (n = 1104), more patients randomized to receive to a single health check, compared with those randomized to receive usual care, received a new antidepressant prescription over 1 year (5% vs 2%; P = .007). In a propensity score-matched analysis (n = 8917), a higher percentage of patients who attended a Medicare Annual Wellness Visit, compared with those who did not, underwent colorectal cancer screening (69% vs 60%; P < .01). General health checks were sometimes associated with modest improvements in health behaviors such as physical activity and diet. In the OXCHECK trial (n = 4121), fewer patients randomized to receive annual health checks, compared with those not randomized to receive health checks, exercised less than once per month (68% vs 71%; difference, 3.3% [95% CI, 0.5%-6.1%]). Potential adverse effects in individual studies included an increased risk of stroke and increased mortality attributed to increased completion of advance directives.CONCLUSIONS AND RELEVANCE General health checks were not associated with reduced mortality or cardiovascular events, but were associated with increased chronic disease recognition and treatment, risk factor control, preventive service uptake, and improved patient-reported outcomes. Primary care teams may reasonably offer general health ...

There was a wide variation in how medical schools teach the physical exam to preclerkship students. Common pedagogical approaches included early initiation of physical exam instruction, use of technology, and methods that support clinical reasoning and competency-based medical education. Approaches used by a minority of schools included interprofessional education, ultrasound, and criterion-based standard setting methods for assessments. Opportunities abound for research into the optimal methods for teaching the physical exam.

Background: Oral case presentations are critical for patient care and student assessment. The best method to prepare early medical students for oral presentations is unknown. Aim: We aimed to develop and evaluate a curriculum of on-line learning and deliberate practice to improve pre-clinical students' case presentation skills. Methods: We developed a web-based, interactive curriculum emphasizing conciseness and clinical reasoning. Using a waitlist control design, we randomly assigned groups of second-year students to receive the curriculum in December 2010 or in April 2011. We evaluated their presentations at three time points. We also examined the performance of an untrained class of students as a historical comparison. Results: We evaluated 132 second-year medical students at three time points. After the curriculum, mean scores of the intervention students improved from 60.2% to 70.1%, while scores of the waitlist control students improved less, from 61.8% to 64.5% ( p 5 0.01 for between-group difference in improvement). Once all students had received the curriculum, mean scores for the intervention and waitlist control students rose to 77.8% and 78.4%, respectively, compared to 68.1% for the untrained comparison students ( p 5 0.0001 compared to all curriculum students). Conclusion: An on-line curriculum followed by deliberate practice improved students' oral presentation skills.

Background and Objectives: Residents as teachers (RAT) and medical students as teachers (MSAT) programs are important for the development of future physicians. In 2010, Northwestern University Feinberg School of Medicine (NUFSM) aligned RAT and MSAT programs, which created experiential learning opportunities in teaching and feedback across the graduate and undergraduate medical education continuum. The purpose of this study was to provide a curricular overview of the aligned program and to evaluate early outcomes through analysis of narrative feedback quality and participant satisfaction. Methods: Program evaluation occurred through analysis of written feedback quality provided within the aligned program and postparticipation satisfaction surveys. A total of 445 resident feedback narratives were collected from 2013 to 2016. We developed a quality coding scheme using an operational definition of feedback. After independent coding of feedback quality, an expert panel established coding consensus. We evaluated program satisfaction and perceived importance through posttraining surveys in residents and fourth-year medical students (M4s). Results: Seventy-nine residents participated in the aligned program and provided high-quality feedback with a relative quality rating of 2.71 (scale 0-3). Consistently high-quality written feedback was provided over the duration of the program and regardless of years of resident participation. Posttraining surveys demonstrated high levels of satisfaction and perceived importance of the program to both residents and M4s. Conclusions: The aligned RAT and MSAT program across the medical education continuum provided experiential learning opportunities for future physician educators with evidence of high-quality written feedback to learners and program satisfaction.

There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.