Does physical examination competence correlate with bedside diagnostic acumen? An observational study

• Published in: Medical teacher Vol. 29; no. 2-3; pp. 199 - 203
• Main Authors: Hatala, Rose, ColE, Gary, Kassen, Barry O., Bacchus, C. Maria, Issenberg, S. Barry
• Format: Journal Article
• Language: English
• Published: England Informa UK Ltd 01-03-2007; Taylor & Francis; Taylor & Francis Ltd
• Subjects: Audiovisual Aids; Canadians; Clinical assessment; Clinical Competence; Correlation analysis; Diagnosis; Education, Medical, Graduate; Examiners; Heart Diseases - diagnosis; Humans; Internal Medicine; Internal Medicine - education; Manikins; Medical Evaluation; Medical students; Medicine; Nervous System Diseases - diagnosis; Patients; Physical Examination; Physical examinations; Physicians; Point-of-Care Systems; Simulation; Canada
• ISSN: 0142-159X; 1466-187X
• DOI: 10.1080/01421590701316506

Aim: To examine the relationship between a physician's ability to examine a standardized patient (SP) and their ability to correctly identify related clinical findings created with simulation technology.
Method: The authors conducted an observational study of 347 candidates during a Canadian national specialty examination at the end of post-graduate internal medicine training. Stations were created that combined physical examination of an SP with evaluation of a related audio-video simulation of a patient abnormality, in the domains of cardiology and neurology. Examiners evaluated a candidate's competence at performing a physical examination of an SP and their accuracy in diagnosing a related audio-video simulation.
Results: For the cardiology stations, the correlation between the physical examination scores and recognition of simulation abnormalities was 0.31 (p < 0.01). For the neurology stations, the correlation was 0.27 (p < 0.01). Addition of the simulations identified 18% of 197 passing candidates on the cardiology stations and 17% of 240 passing candidates on the neurology stations who were competent in their physical examination technique but did not achieve the passing score for diagnostic skills.
Conclusions: Assessments incorporating SPs without physical findings may need to include other methodologies to assess bedside diagnostic acumen.