Hatala Rose, Issenberg S Barry, Kassen Barry O, Cole Gary, Bacchus C Maria, Scalese Ross J
St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, Canada, V6Z 1Y6.
Acad Med. 2007 Oct;82(10 Suppl):S26-9. doi: 10.1097/ACM.0b013e31814002f1.
Many standardized patient (SP) encounters employ SPs without physical findings and, thus, assess physical examination technique. The relationship between technique, accurate bedside diagnosis, and global competence in physical examination remains unclear.
Twenty-eight internists undertook a cardiac physical examination objective structured clinical examination, using three modalities: real cardiac patients (RP), "normal" SPs combined with related cardiac audio-video simulations, and a cardiology patient simulator (CPS). Two examiners assessed physical examination technique and global bedside competence. Accuracy of cardiac diagnosis was scored separately.
The correlation coefficients between participants' physical examination technique and diagnostic accuracy were 0.39 for RP (P < .05), 0.29 for SP, and 0.30 for CPS. Patient modality impacted the relative weighting of technique and diagnostic accuracy in the determination of global competence.
Assessments of physical examination competence should evaluate both technique and diagnostic accuracy. Patient modality affects the relative contributions of each outcome towards a global rating.
许多标准化病人（SP）问诊使用没有体格检查结果的标准化病人，因此评估体格检查技术。体格检查技术、准确的床边诊断和整体体格检查能力之间的关系仍不明确。
28名内科实习医生进行了一项心脏体格检查客观结构化临床考试，采用三种方式：真实心脏病患者（RP）、“正常”标准化病人结合相关心脏视听模拟，以及心脏病患者模拟器（CPS）。两名考官评估体格检查技术和整体床边能力。心脏诊断的准确性单独评分。
参与者的体格检查技术与诊断准确性之间的相关系数，RP组为0.39（P <.05），标准化病人组为0.29，心脏病患者模拟器组为0.30。患者方式影响了技术和诊断准确性在整体能力判定中的相对权重。
体格检查能力评估应同时评估技术和诊断准确性。患者方式会影响每个结果对整体评分的相对贡献。
