TY - JOUR
T1 - A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training
AU - Garibaldi, Brian Thomas
AU - Niessen, Timothy
AU - Gelber, Allan Charles
AU - Clark, Bennett
AU - Lee, Yizhen
AU - Madrazo, Jose Alejandro
AU - Manesh, Reza Sedighi
AU - Apfel, Ariella
AU - Lau, Brandyn D.
AU - Liu, Gigi
AU - Canzoniero, Jenna Van Liere
AU - Sperati, C. John
AU - Yeh, Hsin Chieh
AU - Brotman, Daniel J.
AU - Traill, Thomas A.
AU - Cayea, Danelle
AU - Durso, Samuel C.
AU - Stewart, Rosalyn W.
AU - Corretti, Mary C.
AU - Kasper, Edward K.
AU - Desai, Sanjay V.
N1 - Publisher Copyright:
© 2017 The Author(s).
PY - 2017/10/6
Y1 - 2017/10/6
N2 - 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.
AB - 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.
KW - Bedside medicine
KW - Cardiopulmonary exam
KW - Medical education
KW - Physical examination skills
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U2 - 10.1186/s12909-017-1020-2
DO - 10.1186/s12909-017-1020-2
M3 - Article
C2 - 28985729
AN - SCOPUS:85030686820
SN - 1472-6920
VL - 17
JO - BMC medical education
JF - BMC medical education
IS - 1
M1 - 182
ER -