Marshall Hannah, Weingartner Laura A, Henry Taylen, Smith Jensen, Wright Tiffany, Bohnert Carrie A, Shaw M Ann, Adamson Dylan T
Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.
Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.
J Med Educ Curric Dev. 2024 Aug 7;11:23821205241272382. doi: 10.1177/23821205241272382. eCollection 2024 Jan-Dec.
Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum.
We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, = 119) and intervention (2022-2023, = 132) groups.
In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ(1, 251) = 31.0, < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely.
This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.
标准化病人（SP）问诊能让医学生练习体格检查技能和临床推理能力。SP病例用于学习和评估，但录制的问诊也可成为有价值的课程评估工具。我们旨在回顾SP问诊，以提高腹部检查技能和更广泛的体格检查课程水平。
我们回顾了三年级医学生外科实习轮转期间录制的SP问诊。学生检查一名表现为急性右下腹痛的顺性别女性。我们观察腹部检查，以确定哪些操作被尝试并正确完成。然后，我们利用这些结果为后续学生群体制定有针对性的实习培训。我们的干预针对腹部检查的差距，解释如何将腹部检查结果与外科患者的重点病史相结合。我们比较了2021 - 2022年（n = 119）的对照组和2022 - 2023年（n = 132）的干预组三年级医学生，评估了干预对腹部检查技能的影响。
在对照组和干预组中，几乎所有学生都尝试了至少一项一般检查操作，如听诊、触诊、叩诊或反跳痛检查。对照组中只有40%的学生尝试了如罗夫辛征、腰大肌征或闭孔肌征等高级操作。干预后，干预组中75%的学生尝试了高级操作（χ(1, 251) = 31.0，P <.001）。随着实习时间的推移，各队列学生并未获得相关技能。两组学生对反跳痛的评估经常不正确，许多学生完全避开右下象限。
该项目突出了医学生在运用腹部检查操作和整合检查结果方面的困难。结果还表明，学生在实习轮转前或轮转期间并未持续学习高级检查技能，而临床教师可能普遍这样认为。最后，这项工作展示了如何利用SP问诊来评估和改进外科教育课程。
