Effect of a physical examination teaching program on the behavior of medical residents

Abstract

CONTEXT: The reliance on physical examination as a diagnostic aid is in decline. OBJECTIVE: To determine whether an educational program can increase the use of physical examination by medical residents. DESIGN AND PARTICIPANTS: A series of educational workshops were provided to 47 second- and third-year medical residents at a large academic teaching hospital. MEASUREMENTS: Interns and students reported the frequency and depth of clinical examination performance on morning rounds by their residents before and up to six months after the workshops. Behavior before and after the workshops was compared using a mixed model. RESULTS: A total of 374 reports were returned (77% response). After adjusting for the type of service and observer, there was a statistically significant 23% increase (P=.02) in the performance of physical examination among residents who attended the course. Residents significantly increased the fraction of patients they examined on rounds (absolute increase 11%, P=.002) but did not increase the depth of their examination. The change was greatest on general medical teams, among whom the performance of physical examination had been least frequent. Teaching and feedback events on medicine teams by residents to their interns (2.8 and 1.1 events per 2 weeks, respectively) and medical students (5.9 and 2.8 events per 2 weeks, respectively) remained infrequent. CONCLUSIONS: A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.