Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey

Uchida, Toshiko; Achike, Francis I.; Blood, Angela; Boyle, Mary; Farnan, Jeanne M.; Gowda, Deepthiman; Hojsak, Joanne; Ovitsh, Robin K.; Park, Yoon Soo; Silvestri, Ronald C.

doi:10.1097/acm.0000000000002051

Cited by 16 publications

(13 citation statements)

References 28 publications

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“…The high level of diversification in the programs is consistent with previous studies that evaluated physical examination education for undergraduate medical students 29,30 . In addition, a review by Easton and colleagues found several medical models for teaching physical assessment in the published literature, but a general absence of evidence to support the superiority of one model over another 31 .…”

Section: Discussionsupporting

confidence: 81%

Physical assessment educational programs for pharmacists and pharmacy students: A systematic review

Barry

Turgeon

Ellis

2020

J Am Coll Clin Pharm

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Introduction The scope of pharmacy practice has evolved to include physical assessment (PA) as part of the management of drug therapy. Objective To describe programs developed to teach pharmacists/pharmacy students PA and identify factors associated with improved knowledge, skill, confidence, and utilization. Methods A librarian‐assisted search was performed of MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature using the terms “pharmacist,” “student,” and “physical examination,” supplemented with manual reference searches. Studies published exclusively as abstracts were excluded. No language restrictions were applied. Extracted data included design, location, participants, methods of instruction, PA skills taught, assessment, utilization, and follow‐up. Results The search yielded 635 unique citations, which were independently reviewed by two authors. Twenty‐eight articles were reviewed in full and 16 were included. Most studies were conducted in the United States or Canada. Thirteen studies enrolled pharmacy students (mainly second or third year), which focused on comprehensive PA skills or blood pressure measurement. Length of instruction ranged from a single session to a full‐year course. Generally, any type of instruction improved knowledge and confidence with PA. Students preferred pharmacist instructors to other clinicians, and live subjects to simulators/manikins. Three studies evaluated courses for practicing pharmacists, which included comprehensive PA instruction and consisted of 2‐30 contact hours. Participants' confidence with performing PA improved from precourse to postcourse surveys. One study showed improved confidence with performing PA 6 months after the course, while another study showed no improvement in confidence but increased PA use at 6 months postcourse. Utilization of PA after 6 months ranged from 49% to 66%. Conclusions A variety of programs have been developed to teach PA skills to pharmacists/pharmacy students. Limited data suggest that sessions which included pharmacist instructors and live subjects to practice PA skills were preferred. Courses for practicing pharmacists improved confidence with performing PA, but persistent confidence and utilization at 6 months were variable.

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Section: Discussionsupporting

confidence: 81%

Physical assessment educational programs for pharmacists and pharmacy students: A systematic review

Barry

Turgeon

Ellis

2020

J Am Coll Clin Pharm

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“…Since that time additional publications have followed that further clarify resources and roles [6], needs [8], as well as special subgroups of clerkship directors, such as emergency medicine [9] and the medicine sub-internship director [10]. In addition, the educational landscape has markedly evolved to include a new focus on competency-based education CONTACT Gary L. Beck Dallaghan gary_beck_dallaghan@med.unc.edu Office of Medical Education, 108 Taylor Hall, CB#7595, Chapel Hill, NC 27599-7595, USA [11], longitudinal integrated clerkship models [12], utilization of new educational technologies [13][14][15], enhanced early and advanced clinical coursework [16], and a need to accommodate increasing class sizes [17], often requiring increased use of geographically separate clinical sites [18]. Liaison Committee on Medical Education (LCME) standards and elements have evolved since release of the 2003 ACE article [7], resulting in increased responsibilities and accountability for clerkship directors and their schools, including but not limited to monitoring duty hours, providing mid clerkship feedback, and clinical site equivalency.…”

Section: Introductionmentioning

confidence: 99%

Evolving roles of clerkship directors: have expectations changed?

Dallaghan

Ledford

Ander

et al. 2020

Medical Education Online

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“…There is wide variation in how PE is taught, and optimal strategies for PE instruction remain unclear. 24,25 Our study shows that almost half of the surveyed interns reported receiving less than 5 hours of PE training in the fourth year of medical school, raising the possibility that incompletely developed skills or attrition of skills may be present.…”

Section: Discussionmentioning

confidence: 82%

Incoming Interns Recognize Inadequate Physical Examination as a Cause of Patient Harm

Russo

Berg

Davis

et al. 2020

Journal of Medical Education and Curricular Development

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Introduction: As providers of a large portion of the care delivered at academic health centers, medical trainees have a unique perspective on medical error. Despite data suggesting that errors in physical examination (PE) can lead to adverse patient events, we are not aware of previous studies exploring medical trainee perceptions of the relationship between patient harm and inadequate PE. We investigated whether first-year residents at a large tertiary care academic medical center perceive inadequate PE as a cause of adverse patient events. Methods: As part of a larger survey given to incoming interns at Thomas Jefferson University Hospital orientation (2014-2018), the authors examined the perceptions of inadequate PE and adverse patient events. We also examined other details related to PE educational experiences and self-reported PE proficiency. The survey was developed a priori by the authors and assessed for face validity by expert faculty. Results: Ninety-eight percent of respondents (695/706) reported that inadequate PE leads to adverse patient events. Seventy percent (492/706) believe that inadequate PE causes adverse events in up to 10% of all patient encounters, and 30% (214/706) reported that inadequate PE causes adverse events in greater than 10% of patient encounters. Forty-five percent of surveyed interns (319/715) had witnessed a patient safety issue as a result of an inadequate PE. Only 2% of surveyed interns (11/706) did not think patients experience adverse events because of inadequate PEs. Ninety percent of surveyed interns (643/712) reported feeling proficient in performing PE. From 2015 to 2018, 80% (486/604) indicated that they received “just enough” PE education. Conclusion: Nearly all incoming interns surveyed at our institution believe that inadequate PE leads to adverse patient events, and 45% have witnessed an adverse patient event due to inadequate PE. We urge clinicians, educators, and health care administrators to consider enhanced PE skills training as an important and viable approach to medical error reduction, and as such, we propose a 5-pronged intervention for improvement, including a redesign of PE curricula, development of checklist-based assessment methods, ongoing skills training and assessment of physicians-in-practice, rigorous study of PE maneuvers, and research into whether enhanced PE skills improve patient outcomes.

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Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey

Cited by 16 publications

References 28 publications

Physical assessment educational programs for pharmacists and pharmacy students: A systematic review

Physical assessment educational programs for pharmacists and pharmacy students: A systematic review

Evolving roles of clerkship directors: have expectations changed?

Incoming Interns Recognize Inadequate Physical Examination as a Cause of Patient Harm

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