Staitieh Bashar S, Saghafi Ramin, Kempker Jordan A, Schulman David A
Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.
Ann Am Thorac Soc. 2016 Apr;13(4):489-94. doi: 10.1513/AnnalsATS.201505-297OC.
Hypothesis-driven physical examination emphasizes the role of bedside examination in the refinement of differential diagnoses and improves diagnostic acumen. This approach has not yet been investigated as a tool to improve the ability of higher-level trainees to teach medical students.
To assess the effect of teaching hypothesis-driven physical diagnosis to pulmonary fellows on their ability to improve the pulmonary examination skills of first-year medical students.
Fellows and students were assessed on teaching and diagnostic skills by self-rating on a Likert scale. One group of fellows received the hypothesis-driven teaching curriculum (the "intervention" group) and another received instruction on head-to-toe examination. Both groups subsequently taught physical diagnosis to a group of first-year medical students. An oral examination was administered to all students after completion of the course.
Fellows were comfortable teaching physical diagnosis to students. Students in both groups reported a lack of comfort with the pulmonary examination at the beginning of the course and improvement in their comfort by the end. Students trained by intervention group fellows outperformed students trained by control group fellows in the interpretation of physical findings (P < 0.05).
Teaching hypothesis-driven physical examination to higher-level trainees who teach medical students improves the ability of students to interpret physical findings. This benefit should be confirmed using validated testing tools.
假设驱动的体格检查强调床旁检查在完善鉴别诊断中的作用，并提高诊断敏锐度。这种方法尚未作为一种提高高年级实习生教导医学生能力的工具进行研究。
评估向肺科住院医师传授假设驱动的体格诊断对其提高一年级医学生肺部检查技能能力的影响。
通过李克特量表自评对住院医师和学生的教学及诊断技能进行评估。一组住院医师接受假设驱动的教学课程（“干预”组），另一组接受从头到脚检查的指导。两组随后都向一组一年级医学生教授体格诊断。课程结束后对所有学生进行口试。
住院医师对向学生教授体格诊断感到得心应手。两组学生在课程开始时均表示对肺部检查不自信，而在课程结束时自信程度有所提高。干预组住院医师培训的学生在体格检查结果解读方面优于对照组住院医师培训的学生（P<0.05）。
向教导医学生的高年级实习生传授假设驱动的体格检查可提高学生解读体格检查结果的能力。这一益处应使用经过验证的测试工具加以证实。
