Phillips Donna, Pean Christian A, Allen Kathleen, Zuckerman Joseph, Egol Kenneth
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
J Surg Educ. 2017 May-Jun;74(3):513-518. doi: 10.1016/j.jsurg.2016.10.011. Epub 2016 Dec 21.
Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter.
Prospective, uncontrolled, observational.
Northeastern academic medical center.
A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading.
The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases.
This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice.
患者护理是毕业后医学教育认证委员会（ACGME）定义的6项核心能力之一。体格检查（PE）是评估患者并做出准确诊断的一项基本技能。本研究的目的是调查3种不同的教授体格检查技能的方法，并评估在模拟患者诊疗过程中进行完整体格检查的能力。
前瞻性、非对照、观察性研究。
东北学术医疗中心。
共有32名骨科住院医师参与并被分为3个教学组：第1组（n = 12），现场互动讲座、标准化患者演示和教科书阅读；第2组（n = 11），第1组讲座的视频记录和单独的教科书阅读；第3组（n = 9），住院医师以近同伴形式向实习生讲授90分钟模块内容和教科书阅读。
合并组客观结构化临床考试的总体分数为66%。与依赖视频记录的第2组相比，通过现场讲座和演示授课的第1组进行更完整体格检查的趋势更明显。第3组由近同伴授课的住院医师总体表现显著优于第2组住院医师（p = 0.02），并且在总体表现上也有显著优于第1组住院医师的趋势，在踝关节（p = 0.02）和肩部（p = 0.02）体格检查病例中的得分显著更高。
本研究发现，由近同伴教授肌肉骨骼体格检查技能的骨科实习生总体表现优于其他组。合并教学组的总体分数为66%，表明一年级住院医师的肌肉骨骼体格检查技能存在基线缺陷。在整个住院医师培训期间，应继续教授并客观评估体格检查，以确认初出茅庐的外科医生在进入临床实践之前已掌握这些基本技能。
