A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

BMC Medical Education

Research Article

Hsin-Chieh Yeh¹  Ariella Apfel¹  Timothy Niessen²  Reza Sedighi Manesh²  Gigi Liu²  Daniel J. Brotman²  Yizhen Lee²  Jenna VanLiere Canzoniero²  Danelle Cayea²  Bennett Clark²  Rosalyn W. Stewart²  Brandyn D. Lau³  Edward K. Kasper⁴  Mary C. Corretti⁴  Jose Alejandro Madrazo⁴  Thomas A. Traill⁴  Samuel C. Durso⁵  C. John Sperati⁶  Sanjay V. Desai⁷  Brian Thomas Garibaldi⁷  Allan Charles Gelber⁸ 

[1] Department of General Internal Medicine, 2024 E Monument St, 21205, Baltimore, MD, USA;Department of Medicine, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Department of Surgery, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Division of Cardiology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Division of Geriatric Medicine, Johns Hopkins University School of Medicine, 5200 Eastern Avenue 7th Floor, 21224, Baltimore, MD, USA;Division of Nephrology, Johns Hopkins University School of Medicine, 600 North Wolfe Street, 21287, Baltimore, MD, USA;Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, 21287, Baltimore, MD, USA;Division of Rheumatology, Johns Hopkins University School of Medicine, 5200 Eastern Avenue, 21224, Baltimore, MD, USA;

关键词: Medical education;    Physical examination skills;    Cardiopulmonary exam;    Bedside medicine;   

DOI  :  10.1186/s12909-017-1020-2

 received in 2017-05-05, accepted in 2017-09-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundPhysicians 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.MethodsOne 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).ResultsInterns 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.ConclusionsA 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.

【 授权许可】

CC BY   
© The Author(s). 2017