McMahon Graham T, Marina Ovidiu, Kritek Patricia A, Katz Joel T
Department of Medicine, Brigham & Women's Hospital, Boston, MA 02115, USA.
J Gen Intern Med. 2005 Aug;20(8):710-4. doi: 10.1111/j.1525-1497.2005.0159.x.
The reliance on physical examination as a diagnostic aid is in decline.
To determine whether an educational program can increase the use of physical examination by medical residents.
A series of educational workshops were provided to 47 second- and third-year medical residents at a large academic teaching hospital.
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.
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.
A skills improvement program can significantly increase the frequency of physical examination, but teaching and feedback events remain sporadic and infrequent.
作为一种诊断辅助手段，体格检查的应用正在减少。
确定一项教育计划能否增加住院医师对体格检查的应用。
为一家大型学术教学医院的47名二、三年级住院医师提供了一系列教育工作坊。
实习医生和学生报告了住院医师在工作坊之前及之后长达6个月的晨间查房中临床检查表现的频率和深度。使用混合模型比较工作坊前后的行为。
共收到374份报告（回复率77%）。在对服务类型和观察者进行调整后，参加课程的住院医师进行体格检查的表现有统计学意义的23%的增加（P = 0.02）。住院医师显著增加了他们在查房时检查的患者比例（绝对增加11%，P = 0.002），但没有增加检查的深度。这种变化在普通内科团队中最大，他们进行体格检查的频率最低。住院医师对实习医生（分别为每2周2.8次和1.1次）和医学生（分别为每2周5.9次和2.8次）在医疗团队中的教学和反馈活动仍然很少。
一项技能提升计划可以显著增加体格检查的频率，但教学和反馈活动仍然零星且不频繁。
