Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists

Abstract

BACKGROUND AND OBJECTIVES:Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups' self-confidence in and perceived utility of physical examination skills. DESIGN AND PARTICIPANTS:Cross-sectional survey of third-and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital. MEASUREMENTS:Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information. RESULTS:The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than "neutral" were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students' ratings (3.3) were similar to those of first-year residents (3.4; p=.95) but less than those of fourth-year students (3.8; p=.002), upper-level residents (3.7; p=.01), and faculty Internists (3.9; p<.001).CONCLUSIONS: Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions.

The Teaching of Clinical Skills and the Applicability of a Simplified Guide to Physical Examination in Undergraduate Medical Training

“…Clinical assessment of this gland is poorly performed in medical practice, so much so that Wu et al 27 Regarding breast examination, it was reported that only 5.26% of the students performed this exam, and even so only partially, before the intervention with the guide. After the training, this rate increased to 68.42%, but there was still a low percentage of assessments considered complete (36.84%).…”

O Ensino de Habilidades Clínicas e a Aplicabilidade de um Guia Simplificado de Exame Físico na Graduação de Medicina

“…O exame da tireoide passou de 0% para 61,29% de avaliações completas. A avaliação clínica desta glândula é pouco realizada na prática médica, tanto que Wu et al 27 , em 2007, encontraram um nível de autoconfiança de 2,8 (escala de 1 a 5, sendo 1 o menor nível de confiança) entre os estudantes de Medicina na detecção de um nódulo na tireoide. Porém, com simples intervenções, este cenário é passível de mudança, como foi visto no presente estudo e no trabalho de Haring et al 28 , em 2014.…”

Addressing the ‘forgotten art of fundoscopy’: evaluation of a novel teaching ophthalmoscope

“…Since then, medical students, junior doctors, and general practitioners have consistently reported low levels of confidence in ophthalmoscopy. [4][5][6][7][8] Although some parties have suggested that direct ophthalmoscopy might be replaced by ocular fundus photographs, 3,9 pan-optic ophthalmoscopes 2,10 or by smartphone technology, 11 the reality is that the conventional handheld direct ophthalmoscope remains the most readily accessible tool for fundoscopy to the majority of frontline clinicians. It can be used to quickly and effectively detect a number of lifethreatening and disabling diseases and so remains a diagnostic tool with which all graduating doctors should be familiar.…”