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- Title
A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training.
- Authors
Garibaldi, Brian Thomas; Niessen, Timothy; Gelber, Allan Charles; Clark, Bennett; Yizhen Lee; Madrazo, Jose Alejandro; Manesh, Reza Sedighi; Apfel, Ariella; Lau, Brandyn D.; Liu, Gigi; Canzoniero, Jenna VanLiere; Sperati, C. John; Yeh, Hsin-Chieh; Brotman, Daniel J.; Traill, Thomas A.; Cayea, Danelle; Durso, Samuel C.; Stewart, Rosalyn W.; Corretti, Mary C.; Kasper, Edward K.
- Abstract
Background: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. Methods: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey and a validated online cardiovascular examination (CE). Results: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. Conclusions: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
- Subjects
PHYSICAL diagnosis; INTERNAL medicine; GRADUATE students; CONTINUING medical education; PHYSICIAN-patient relations; TRAINING
- Publication
BMC Medical Education, 2017, Vol 17, p1
- ISSN
1472-6920
- Publication type
Article
- DOI
10.1186/s12909-017-1020-2