Loh Meredith S, Gevitz Norman, Gilliar Wolfgang G, Iacono Lauren M, Jung Min-Kyung, Krishnamachari Bhuma, Amsler Kurt
From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz).
From the New York Institute of Technology College of Osteopathic Medicine (NYIT-COM) in Old Westbury (Student Doctors Loh and Iacono and Drs Gilliar, Jung, Krishnamachari, and Amsler) and the A.T. Still University-Kirskville College of Osteopathic Medicine in Missouri (Dr Gevitz)
J Am Osteopath Assoc. 2015 Jan;115(1):32-40. doi: 10.7556/jaoa.2015.005.
Although palpation is a central skill in the practice of osteopathic medicine, few data are available on factors affecting the development of palpatory skills.
To use a novel palpatory skills assay to assess the role of training and practice in the development of palpatory skills in an osteopathic medical student population.
The palpatory skills of first-year osteopathic medical students were assessed using a simple, objective palpation assay that consisted of locating a dime placed under sheets of copy paper at depths of 50, 100, 150, 200, 300, and 400 sheets. Two trials were performed at each depth. The assay was performed at the beginning and at the end of the students' first term. To determine whether practice with the assay impacted participant performance, a third assay was conducted to compare the performance of students who completed the assays at the beginning and at the end of the term with that of students who had never completed the assay.
Sixty-three participants completed the assays at the beginning and end of the term. Fifty-seven of those 63 participants and 192 participants who had not previously completed the assay completed the third assay. A wide variability in number of correct responses per participant was observed at both the beginning (range, 0-11 correct) and the end (range, 2-12 correct) of the term. The mean (SD) number of correct responses per participant increased from the beginning (5.49 [2.78]) to the end (7.17 [2.27]) of the term. Analysis using the generalized estimating equation model demonstrated that both paper depth and experience (ie, beginning vs end of the term) were statistically significant determinants of the number of correct responses (P<.001). The Kaplan-Meier method indicated that the median paper depth at which participants first scored no correct responses increased from 200 sheets (95% CI, 171-229) at the beginning of the term to 300 sheets (95% CI, 232-367) at the end of the term (P<.001). In the third assay, no significant differences were noted in the performance of students who had completed the 2 previous assays vs participants who had not completed the previous assays (P=.136).
Participants' palpatory skills improved from the beginning to the end of the term. The range of participants' palpatory skills at the beginning of the term suggests that other factors in addition to training influenced participants' palpatory skill level. Additional research is needed to identify and investigate factors that influence the development of palpatory skills.
尽管触诊是整骨医学实践中的一项核心技能，但关于影响触诊技能发展的因素的数据却很少。
使用一种新颖的触诊技能测定方法来评估培训和练习在整骨医学学生群体触诊技能发展中的作用。
使用一种简单、客观的触诊测定方法评估一年级整骨医学学生的触诊技能，该方法包括在50、100、150、200、300和400张复印纸下找到一枚放置的一角硬币。每个深度进行两次试验。该测定在学生第一学期开始时和结束时进行。为了确定使用该测定方法进行练习是否会影响参与者的表现，进行了第三次测定，以比较在学期开始和结束时完成测定的学生与从未完成过该测定的学生的表现。
63名参与者在学期开始和结束时完成了测定。这63名参与者中的57名以及192名之前未完成测定的参与者完成了第三次测定。在学期开始时（范围为0 - 11个正确）和结束时（范围为2 - 12个正确），每个参与者的正确反应数量都存在很大差异。每个参与者的正确反应的平均（标准差）数量从学期开始时的5.49（2.78）增加到结束时的7.17（2.27）。使用广义估计方程模型进行的分析表明，纸张深度和经验（即学期开始与结束）都是正确反应数量的统计学显著决定因素（P <.001）。Kaplan - Meier方法表明，参与者首次得分为无正确反应的纸张深度中位数从学期开始时的200张（95%置信区间，171 - 229）增加到学期结束时的300张（95%置信区间，232 - 367）（P <.001）。在第三次测定中，完成前两次测定的学生与未完成前两次测定的参与者的表现没有显著差异（P = 0.136）。
参与者的触诊技能从学期开始到结束有所提高。学期开始时参与者触诊技能的范围表明，除了培训之外的其他因素也影响了参与者的触诊技能水平。需要进一步的研究来识别和调查影响触诊技能发展的因素。
