Fourth-year medical students do not perform a focused physical examination during a case-based simulation scenario

Abstract

BackgroundThe art of physical examination is one of the most valuable diagnostic tools bestowed upon new generations of medical students. Despite traditional educational techniques and significant attention on a national level, both trainees and educators have noticed a decrease in physical examination proficiency. Simulation has been identified as a potential way to improve physical examination techniques within undergraduate medical education. We sought to determine the utility of a cardiac case-based simulation scenario to assess physical examination performance of fourth-year medical students during an emergency medicine (EM) clerkship.Materials and methodsFourth-year medical students enrolled in a 4-week EM clerkship were prospectively evaluated during a case-based scenario using a simulation mannequin (Laerdal SimMan®). The case involved a patient presenting with chest pain that evolved into cardiac arrest. All simulations were video recorded and two emergency physicians reviewed each video. The reviewers recorded whether or not each student completed the essential components of a focused physical examination.ResultsTwenty-seven students participated in the simulation. The percentage of students completing each of the four components of the physical examination was as follows: cardiac auscultation 33.3% (95% CI 18.5–52.3), lung auscultation 29.6% (95% CI 15.7–48.7), pulse and extremity examination 55.6% (95% CI 37.3–72.4), and abdominal examination 3.70% (95% CI 0–19.8). None of the students completed all four of these components.ConclusionOur study showed that fourth-year medical students did not uniformly perform components of a focused physical examination during a high-acuity chest pain simulation scenario. Although our study showed limited physical examination performance, simulation allows evaluators to observe and provide constructive feedback and may lead to an improvement in these skills. These findings call for improved technology to increase authenticity of simulators and continued faculty development for more creative, meaningful integration of physical examination skills into high-acuity simulation cases.

Technology Complements Physical Examination and Facilitates Skills Development among Health Sciences Clerkship Students: <em>An Integrative Literature Review</em>

“…This theme was constructed from two observational studies and describes how technology leads to disjunctions between education and practice [ 8 56 ]. These observations suggested misalignments between learning and practice, pointing out insufficient engagement between both touch and technology, although the studies had very different findings.…”

Desenvolvimento da competência clínica por estudantes graduandos no ensino baseado em simulação: estudo quase experimental

“…A result similar to the percentage of correct answers for the cardiopulmonary monitoring skill was found in a study carried out at the Faculty of Medicine of Ribeirão Preto, in which 83% of candidates for medical residency requested electrocardiographic monitoring during the assess- (14) . On the other hand, research carried out at the Beth Israel Deaconess Medical Center pointed out that fourth-year medical students did not adequately perform the patient's anamnesis, demonstrating limited performance in the physical examination during a simulation of chest pain with a high-fidelity mannequin (15) . The "immediate treatment" competency encompasses skills such as oxygen therapy and medication administration according to the protocol (8) , in which the students had high percentages of correct answers from 96.7% to 100%, demonstrating decision-making and attitude when performing properly.…”

The Effectiveness of Training on Auscultation of Heart with a Simulator of Cardiology in Medical Students

“…In general, acquiring heart auscultation skills are a difficult task. The gradual deterioration of the quality of education is caused by: time limits, low availability of thematic patients, the severity of the patient's condition, the presence of psychological problems in students when working with a real patient, the direct refusal of patients to communicate with students [15].…”

“…In other studies, weak cardiological examination skills were recorded in medical students using cardiac simulators [7], [8], computer training programs [9], and at the patient's bedside [10], [11]. In several well-planned randomized trials, no significant differences were found between heart simulations and other interventions [12], [13], [14], [15]. Thus, it remains unclear whether there is any intervention that can be applied at an early stage of medical training, contributing to the improvement of heart auscultation skills.…”