Berg D, Sebastian J, Heudebert G
Division of General Internal Medicine, Medical College of Wisconsin, Milwaukee.
Acad Med. 1994 Sep;69(9):758-64. doi: 10.1097/00001888-199409000-00023.
To develop, implement, and evaluate a new course curriculum designed to increase senior medical students' knowledge, psychomotor skills, interpretative abilities, and clinical utility regarding physical examination techniques.
From February 1991 through February 1993, 53 fourth-year students at the Medical College of Wisconsin participated in a one-month elective, Advanced Physical Diagnosis (APD), which was taught by faculty members of the Division of General Internal Medicine. The APD course included the following modules: (1) organ-specific didactic and interactive practice sessions; (2) physical-examination-based case conferences; and (3) professorial rounds, consisting of rounds on inpatient medical services and the use of professional patients, i.e., outpatients with specific, incontrovertible physical findings. An objective structured clinical examination (OSCE) was developed to evaluate the examination skills of the APD students. A pre- and post-course OSCE format was used with both the APD students and a control group of students rotating on the general medicine ward service. In addition, the APD students evaluated their own skills in physical examination and evaluated the course and each of its components by anonymously completing an extensive end-of-course survey.
The pre-course OSCE detection rate of incontrovertible physical findings was similar between the control and APD students (Mantel-Haenszel chi 2 = 2.4, p > .1); the post-course OSCE showed significant improvement in the detection rates for the APD students compared with the control students (Mantel-Haenszel chi 2 = 45.8, p < .0001). The APD students felt strongly that the course had improved their physical examination skills and highly recommended the elective to their colleagues.
Both the OSCE results and the students' self-assessments indicate that the pilot curriculum for the APD course improved the students' physical examination skills. The curriculum can be expanded and also exported to other institutions. Such a course may help promote and refine the use of physical diagnosis in the delivery of quality, timely, and cost-efficient health care.
开发、实施并评估一门新课程，该课程旨在提高高年级医学生在体格检查技术方面的知识、操作技能、解读能力及临床应用能力。
1991年2月至1993年2月，威斯康星医学院的53名四年级学生参加了为期一个月的选修课程“高级物理诊断（APD）”，该课程由普通内科教研室的教员授课。APD课程包括以下模块：（1）特定器官的理论与互动实践课程；（2）基于体格检查的病例讨论会；（3）教授查房，包括住院医疗服务查房以及使用专业患者，即具有特定、明确体格检查结果的门诊患者。开发了一项客观结构化临床考试（OSCE）来评估APD学生的检查技能。对APD学生和在内科病房轮转的对照组学生均采用了课程前后的OSCE形式。此外，APD学生通过匿名完成一份详尽的课程结束调查问卷，对自己的体格检查技能进行评估，并对课程及其各个组成部分进行评价。
课程前OSCE中，对照组和APD学生对明确体格检查结果的检出率相似（Mantel-Haenszel卡方检验=2.4，p>.1）；课程后OSCE显示，与对照组学生相比，APD学生的检出率有显著提高（Mantel-Haenszel卡方检验=45.8，p<.0001）。APD学生强烈认为该课程提高了他们的体格检查技能，并向同事大力推荐该选修课程。
OSCE结果和学生的自我评估均表明，APD课程的试点课程提高了学生的体格检查技能。该课程可以扩展并推广到其他机构。这样的课程可能有助于在提供高质量、及时且具成本效益的医疗保健服务过程中促进和完善体格诊断的应用。
