Physical Examination

Wiener, Stanley L.

doi:10.1001/jama.1976.03270080034028

Cited by 75 publications

(7 citation statements)

References 6 publications

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“…With most trainees lacking exposure to a formal curriculum during residency, it is not surprising that a widespread decline in clinical skills has been reported. 9–20 …”

Section: Discussionmentioning

confidence: 99%

“…9–20 In a 1996 commentary, Mangione and Peitzman argued that one way to improve examination skills is for “teachers of physical diagnosis [to] separate wheat from chaff and discard signs or maneuvers of little value.” 6 This approach requires examination findings to be viewed as diagnostic tests each with their own test characteristics. 21–25 Fortunately, the recent focus on the principles of evidence-based medicine has led to the determination of these characteristics for a number of findings.…”

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confidence: 99%

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Bayesʼ Theorem and the Physical Examination: Probability Assessment and Diagnostic Decision Making

et al. 2011

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Purpose To determine how examination findings influence the probability assessment and diagnostic decision-making of third- and fourth-year medical students, internal medicine residents, and academic general internists. Method In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived pre-examination probabilities (pre-EPs) for each condition and were asked to 1) estimate post-examination probabilities (post-EPs) and 2) select a diagnostic choice (either report that condition is present, order more tests to establish diagnosis, or report that condition is absent). Participants’ inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs. Results Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants’ ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P <.001 for each). In three of the four scenarios consisting of negative findings, ITL mean post-EPs were significantly greater than corresponding literature-derived post-EP point estimates (P <.001 for each). In the four scenarios with positive findings, 17%–38% of participants ordered more diagnostic tests when the literature indicated a >85% probability that the condition was present. In the four scenarios with largely negative findings, 70%–85% chose to order diagnostic tests to further reduce diagnostic uncertainty. Conclusions All three groups tended to similarly underestimate the impact of examination findings on condition probability assessment, especially negative findings, and often ordered more tests when probabilities indicated that additional testing was unnecessary.

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“…With most trainees lacking exposure to a formal curriculum during residency, it is not surprising that a widespread decline in clinical skills has been reported. 9–20 …”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Bayesʼ Theorem and the Physical Examination: Probability Assessment and Diagnostic Decision Making

et al. 2011

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“…The medical interview remains “the most powerful and sensitive and most versatile instrument available to the physician.” 10 Inaccurate and incomplete patient histories are among the leading causes for diagnostic errors. 11 , 12 As a course director of a Physical Diagnosis Course and the Comprehensive Clinical Competencies Examination and educator of bedside medicine, I have witnessed poor interviewing skills by students, which are key to problem detection and accuracy of diagnoses. Reports indicate that physicians are able to collect 60% to 80% of the information relevant for a diagnosis just by taking a medical history, 13 - 16 leading to a final diagnosis in more than 70% of cases.…”

Section: Introductionmentioning

confidence: 99%

The decline of clinical skills: a challenge for medical schools

Faustinella

Jacobs

2018

Int J Med Educ

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“…Many institutions have also integrated the use of standardized patient models, objective structure clinical examinations, and simulation-based teaching for additional education and evaluation of physical examination skills [1][2][3]. However, several studies have demonstrated a decline in physical examination skills among medical students and residents [4][5][6]. This has been attributed to various factors, including an increased reliance on high-technology diagnostic testing and a decrease in supervised bedside instruction [7][8][9].…”

Section: Introductionmentioning

confidence: 99%

Resident Accuracy of Joint Line Palpation Using Ultrasound Verification

Rho

Chu

Yang

et al. 2014

PM&R

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Residents in this study demonstrate poor accuracy of AC joint and lateral knee joint line identification by palpation, using US as the criterion standard for verification. There were no statistically significant differences in the accuracy rates of joint line palpation based on resident level of education. US may be a useful tool to use to advance the current methods of teaching the physical examination in medical education.

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Physical Examination

Cited by 75 publications

References 6 publications

Bayesʼ Theorem and the Physical Examination: Probability Assessment and Diagnostic Decision Making

Bayesʼ Theorem and the Physical Examination: Probability Assessment and Diagnostic Decision Making

The decline of clinical skills: a challenge for medical schools

Resident Accuracy of Joint Line Palpation Using Ultrasound Verification

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