Fodor Daniela, Badea Radu, Poanta Laura, Dumitrascu Dan Lucian, Buzoianu Anca Dana, Mircea Petru-Adrian
2nd Internal Medicine Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Med Ultrason. 2012 Sep;14(3):177-81. doi: 10.11152/mu.2013.2066.143.df177.
Physical examination is a crucial part in medical student curricula, but a decline in physical examination skills was noted in the last two decades. The benefic role of ultrasonography (US) as an adjuvant method for clinical examination was evaluated in many studies, but there are different approaches among countries and universities. The aim of this study was to evaluate the role of US in learning physical exam in 3rd year medical students.
One hundred and four 3rd year medical students were randomly enrolled. They were divided first in two equal groups (I and II, with and without US, by rotation) and then in smaller groups of 8-9 students. Pairs between smaller groups belonging to group I and II were randomly established in order to be trained and evaluated by the same instructor. We verified the influence of US on the correctness of thyroid palpation, lung percussion (inferior limit of the lung), and liver size estimation. They received no special training on US. After the learning sessions (four sessions, one hour each) a questionnaire was applied to each student.
For thyroid palpation, there were no significant differences regarding the gland dimensions. For lung and liver palpation the results showed better results for some points in groups using US as adjuvant, but the most significant difference regarded the appreciation of self confidence (in favor of US-groups). The majority of the students using US appreciated as very useful the informations provided by US. Also, we found a clear improvement in detecting the upper limit of the liver comparing with the inferior limit of the lung, as result of better clinical skills.
The results from this pilot study proved the utility of US in learning clinical examination. The students can better understand the regional anatomy and can confirm immediately the physical findings. It is important for students to reach a certain level of knowledge regarding physical exam to better understand the role of US. Overall, we can state that use of US in the daily clinical examination teaching greatly improved the students' clinical examination abilities and that is a strong argument for integrating basic US into the medical school curriculum.
体格检查是医学生课程的重要组成部分，但在过去二十年中，体格检查技能有所下降。超声检查（US）作为临床检查辅助方法的有益作用在许多研究中得到了评估，但不同国家和大学的方法存在差异。本研究的目的是评估超声检查在三年级医学生学习体格检查中的作用。
随机招募了104名三年级医学生。他们首先被分为两个相等的组（I组和II组，通过轮转分别有和没有超声检查），然后再分为8 - 9名学生的小组。I组和II组中较小的小组之间随机配对，以便由同一名教师进行培训和评估。我们验证了超声检查对甲状腺触诊、肺部叩诊（肺下界）和肝脏大小估计准确性的影响。他们没有接受关于超声检查的特殊培训。在学习课程（四节，每节一小时）结束后，对每个学生进行问卷调查。
对于甲状腺触诊，腺体大小方面没有显著差异。对于肺部和肝脏触诊，结果显示在使用超声检查作为辅助的组中，某些点的结果更好，但最显著的差异在于自我信心的评估（有利于使用超声检查的组）。大多数使用超声检查的学生认为超声检查提供的信息非常有用。此外，由于临床技能的提高，与肺下界相比，在检测肝脏上界方面有明显改善。
这项初步研究的结果证明了超声检查在学习临床检查中的实用性。学生可以更好地理解局部解剖结构，并能立即确认体格检查结果。学生达到一定的体格检查知识水平对于更好地理解超声检查的作用很重要。总体而言，我们可以说在日常临床检查教学中使用超声检查极大地提高了学生的临床检查能力，这是将基础超声检查纳入医学院课程的有力论据。
