医学生核心体格检查：一项全国性调查结果。

A core physical exam for medical students: results of a national survey.

机构信息

Dr. Gowda is assistant professor of medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Blatt is professor of medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC. Dr. Fink is assistant professor of medicine, Program in Family Medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York. Dr. Kosowicz is associate professor of medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut. Ms. Baecker is a PhD candidate in epidemiology, University of California at Los Angeles, Los Angeles, California. At the time of this study, Ms. Baecker was an MPH candidate, Columbia University Mailman School of Public Health, New York, New York. Dr. Silvestri is assistant professor of medicine, Department of Medicine, Harvard Medical School, and physician, Beth Israel Deaconess Medical Center, Boston, Massachusetts.

出版信息

Acad Med. 2014 Mar;89(3):436-42. doi: 10.1097/ACM.0000000000000137.

DOI:10.1097/ACM.0000000000000137

PMID:24448049

Abstract

PURPOSE

Medical students are traditionally taught the physical exam as a comprehensive battery of maneuvers, yet they express uncertainty about which maneuvers are "core" and should be performed routinely on patients and which ones should be performed only when clinically indicated. The authors sought to determine whether educator consensus existed on the concept and the specifics of a core physical exam for students.

METHOD

The authors developed a 45-maneuver core physical exam to be performed by a medicine clerkship student on every newly admitted patient, with the expectation that it would be supplemented by clinically indicated additional maneuvers. From 2011 to 2012 they sent surveys to physical diagnosis course directors (PDCDs) and internal medicine clerkship directors (IMCDs) from all 132 U.S. allopathic medical schools to determine the extent of their agreement with the proposed 45 maneuvers and their opinions about the concept of a core exam.

RESULTS

Seventy-one percent (94/132) of PDCDs and 63% (83/132) of IMCDs responded to the survey. In total, 84% (111/132) of all schools surveyed were represented by either their PDCD or IMCD. Of the 45 proposed maneuvers, 37 were deemed "core" by a majority of respondents. The majority of IMCDs preferred a slightly leaner 37-maneuver core exam than the majority of PDCDs, who voted for 41 maneuvers.

CONCLUSIONS

Among PDCDs and IMCDs, there was openness to teaching medical students a streamlined core physical exam to which other maneuvers are added as clinically indicated. These educators closely agreed on the maneuvers this core exam should include.

摘要

目的

传统上，医学生学习体格检查是作为一系列综合操作来进行的，但他们对哪些操作是“核心”、应该常规在患者身上进行，以及哪些操作应该仅在临床指征下进行存在不确定性。作者试图确定教育者是否对学生核心体格检查的概念和具体内容达成共识。

方法

作者开发了一个由 45 项操作组成的核心体格检查，由内科实习医学生对每一位新入院的患者进行检查，期望它能补充临床指征下的其他操作。在 2011 年至 2012 年期间，他们向所有 132 所美国传统医学院的物理诊断课程主任（PDCD）和内科实习主任（IMCD）发送了调查，以确定他们对拟议的 45 项操作的同意程度，以及他们对核心检查概念的看法。

结果

71%（94/132）的 PDCD 和 63%（83/132）的 IMCD 对调查做出了回应。共有 84%（111/132）的被调查学校由其 PDCD 或 IMCD 代表。在提出的 45 项操作中，有 37 项操作被大多数受访者认为是“核心”。与 PDCD 相比，大多数 IMCD 更倾向于稍简洁的 37 项操作核心检查，而 PDCD 投票选择 41 项操作。