Department of Orthopaedics, The Ohio State University, 2050 Kenny Road, Suite 3100, Columbus, OH 43221, USA.
J Bone Joint Surg Am. 2012 Mar 21;94(6):e36. doi: 10.2106/JBJS.K.00518.
Although the musculoskeletal physical examination is an essential part of patient encounters, we believe that it is underemphasized in residency education and that residents' physical examination skills may be lacking. We sought to assess attitudes regarding teaching of the physical examination in orthopaedic residencies, to assess physical examination knowledge and skills among residents, and to develop a method to track the skill level of residents in order to improve our physical examination curriculum.
We created a thirty-question multiple-choice musculoskeletal physical examination test and administered it to our residents. We created a five-question survey assessing attitudes toward physical examination teaching in orthopaedic residencies and distributed it to U.S. orthopaedic department chairs We developed an Objective Structured Clinical Examination (OSCE), in which standardized patients enact four clinical scenarios, to observe and assess physical examination skills.
The mean score on the multiple-choice physical examination test was 76% despite the fact that our residents consistently scored above 90% on the Orthopaedic In-Training Examination. Department chairs and residents agreed that, although learning to perform the physical examination is important, there is not enough time in the clinical setting to observe and critique a resident's patient examination. The overall score of our residents on the OSCE was 66%.
We have exposed a deficiency in the physical examination knowledge and skills of our residents. Although the musculoskeletal physical examination is a vital practice component, our data indicate that it is likely underemphasized in training. Clinic time alone is likely insufficient for the teaching and learning of the musculoskeletal physical examination.
尽管肌肉骨骼系统体格检查是医患接触的重要组成部分，但我们认为它在住院医师教育中被低估了，而且住院医师的体格检查技能可能有所欠缺。我们旨在评估骨科住院医师教学中体格检查的态度，评估住院医师的体格检查知识和技能，并制定一种方法来跟踪住院医师的技能水平，以改进我们的体格检查课程。
我们创建了一个包含三十个问题的多项选择肌肉骨骼系统体格检查测试，并对我们的住院医师进行了测试。我们创建了一个五项调查问题，评估骨科住院医师教学中体格检查的态度，并分发给美国骨科部门主席。我们开发了一种客观结构化临床考试（OSCE），标准化患者在四个临床场景中扮演角色，以观察和评估体格检查技能。
尽管我们的住院医师在骨科住院医师培训考试中的得分始终高于 90%，但多项选择体格检查测试的平均得分为 76%。系主任和住院医师都认为，尽管学习进行体格检查很重要，但在临床环境中没有足够的时间观察和批评住院医师的患者检查。我们的住院医师在 OSCE 中的总得分是 66%。
我们已经发现我们的住院医师在体格检查知识和技能方面存在不足。尽管肌肉骨骼系统体格检查是重要的实践组成部分，但我们的数据表明，它在培训中可能被低估了。仅靠临床时间可能不足以教授和学习肌肉骨骼系统体格检查。
