The Master Clinician’s Elective: Integrating Evidence-Based Physical Examination and Point of Care Ultrasonography in Modern Clinical Medicine

Abstract

Background: Many internal medicine residency programs have incorporated ultrasonography into their curriculum; however, its integration with physical examination skills teaching at a graduate medical level is scarce. The program’s aim is to create a reproducible elective that combines physical exam and bedside ultrasound as a method for augmenting residents’ knowledge and competence in these techniques with the ultimate goal of improving patient care. Methods: We designed and implemented a two-week elective rotation for senior internal medicine residents, combining evidence-based physical examination with diagnostic bedside ultrasonography. The rotation took place in an inpatient setting at Denver Health Hospital. Program evaluation data was collected data between February 2016 to March 2019. IRB approval was waived. Results: Since its inception in 2016, 19 residents completed the rotation. Residents performed a pre-test and a post-test under direct observation by course faculty. Each resident was measured on the ability to perform pre-determined physical exam and point-of-care ultrasound (POCUS) skills. In the pre-test, participants correctly performed an average of 40% of expected physical exam maneuvers and 32% of expected POCUS skills. At elective conclusion, all participants were effectively able to demonstrate the highest yield physical exam and ultrasound maneuvers. Discussion and Conclusion: An elective designed specifically to integrate POCUS and physical exam modalities improves the ability of resident physicians to utilize both diagnostic modalities.

The combination of physical examination and point-of-care ultrasonography in undergraduate medical education

“…Medical students may need to be trained in basic US knowledge and skills before they effectively learn physical examination skills using US in clinical clerkship [2,12,13]. Alternatively, they may need to reach a minimum level of competence in performing physical examinations before they are able to benefit from the feedback from US [2,14].…”

“…Over the decades, the widespread availability of medical imaging modalities such as US and CT has decreased physicians' reliance on physical examinations for establishing diagnoses and reduced their confidence in their physical examination skills [14]. The advent of POCUS has caused some anxiety that it was meant to replace physical examinations, while physical examinations cannot and must not be replaced by POCUS [15].…”