CREATION AND ASSESSMENT OF A STRUCTURED REVIEW COURSE IN PHYSICAL DIAGNOSIS FOR MEDICAL RESIDENTS

被引：29

作者：

MANGIONE, S

PEITZMAN, SJ

GRACELY, E

NIEMAN, LZ

机构：

[1] Department of Medicine, Medical College of Pennsylvania, Philadelphia, Pennsylvania, 19129

来源：

JOURNAL OF GENERAL INTERNAL MEDICINE | 1994年 / 9卷 / 04期

关键词：

EDUCATION; RESIDENTS; PHYSICAL EXAMINATION; DIAGNOSTIC SKILLS; PERFORMANCE ASSESSMENT;

D O I：

10.1007/BF02600127

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Objective: To evaluate the effects of a course in physical diagnosis on the knowledge, skills, and attitudes of internal medicine trainees. Design: A controlled, prospective assignment of housestaff to a year-long curricular program, linked to a set of pre- and posttests. House-officers who could not attend the teaching sessions functioned as control subjects. Setting: An internal medicine training program at an urban medical school. Subjects: 56 (86.1%) of 65 eligible internal medicine housestaff (post-graduate years 1 through 3) participated in the intervention and assessment. A comparison group of 14 senior medical students participated in the pretest. Intervention: 12 monthly lectures emphasizing skills useful in emergencies or validated by the literature. Measurements: The pre- and posttests included: 1) a multiple-choice questionnaire to assess knowledge; 2) professional standardized patients to assess selected skills; and 3) Likert-type questionnaires to assess self-motivated learning and attitude toward diagnosis not based on technology. Main results: The residents expressed interest in the program and on a six-point scale rated the usefulness of lectures and standardized patients as 3.5 +/- 1.3 and 4.3 +/- 1, respectively. For no system tested, however, did they achieve more than 55.2% correct answers (range: 24.2% - 55.2%, median = 41.04), and their performance did not differ from that of the fourth-year medical students. There was no significant difference in pre/posttest improvement between the control and intervention groups. Conclusions: These data confirm the deficiencies of physical diagnostic skills and knowledge among physicians in training. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experiential program made part of residency requirements.

引用

页码：213 / 218

页数：6

共 15 条

[1]

Kern D.C., Parrino T.A., Korst D.R., The lasting value of clinical skills, JAMA, 254, (1985)

[2]

Mandel J.H., Rich E.C., Luxenberg M.G., Spillane M.T., Kern D.C., Parrino T.A., Preparation for practice in internal medicine. A study of ten years of residency graduates, Arch Intern Med, 148, (1988)

[3]

Herbers J.E., Noel G.L., Cooper G.S., Harvey J., Pangaro L.N., Weaver M.J., How accurate are faculty evaluations of clinical competence?, J Gen Intern Med, 4, (1989)

[4]

Noel G.L., Herbers J.E., Caplow M.P., Cooper G.S., Pangaro L.N., Harvey J., How well do internal medicine faculty members evaluate the clinical skills of residents?, Ann Intern Med, 117, (1992)

[5]

Norcini J.J., Webster G.D., Grosso L.J., Blank L.L., Benson J.A., Ratings of residents’ clinical competence and performance on certification examination, J Med Educ, 62, (1987)

[6]

Collins G.F., Cassie J.M., Daggett C.J., The role of the attending physician in clinical training, J Med Educ, 53, (1978)

[7]

Wray N.P., Friedland J.A., Detection and correction of house staff error in physical diagnosis, JAMA, 249, (1983)

[8]

Aloia J.F., Jonas E., Skills in history-taking and physical examination, J Med Educ, 51, (1976)

[9]

Wiener S., Nathanson M., Physical examination. Frequently observed errors, JAMA, 236, (1976)

[10]

Mangione S., Nieman L.Z., Gracely E., Kaye D., The teaching and practice of cardiac auscultation during internal medicine and cardiology training. A nationwide survey, Ann Intern Med, 119, pp. 47-54, (1993)

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