Johnson J E, Carpenter J L
Arch Intern Med. 1986 May;146(5):937-41.
One hundred twenty patients admitted to the medical service and presented at one of two teaching conferences were examined to evaluate the nature of errors made in physical examination by house officers. The overall mean error rate per patient was 5.8% +/- 0.6% for residents and 6.4% +/- 0.6% for interns. The mean error rate for cardiac examination was significantly worse than for respiratory, abdominal, or thyroid examinations. An additional 40 patients selected for abnormal cardiac or neurologic findings were found to have a significantly higher mean error rate in those areas than did the first group of patients with less abnormal findings. Agreement in physical findings between investigators was significantly better than between investigators and house officers. Resident performance in physical examination correlated with estimates of relative time spent by attending physicians at the bedside reevaluating physical findings, but not with class-ranking and inservice examination scores. Educational implications are discussed.
对入住内科病房并在两场教学会议之一上接受检查的120名患者进行了检查，以评估住院医生在体格检查中所犯错误的性质。住院医生每位患者的总体平均错误率为5.8%±0.6%，实习医生为6.4%±0.6%。心脏检查的平均错误率明显高于呼吸、腹部或甲状腺检查。另外选取了40名有心脏或神经系统异常表现的患者，发现这些部位的平均错误率明显高于第一组异常表现较少的患者。检查者之间在体格检查结果上的一致性明显优于检查者与住院医生之间的一致性。住院医生在体格检查中的表现与主治医生在床边重新评估体格检查结果所花费的相对时间估计值相关，但与班级排名和在职考试成绩无关。文中讨论了其教育意义。
