title: Error patterns of 3rd-year medical students on the cardiovascular physical examination.
abstract: BACKGROUND
  Recent research documents widespread deficits in the physical examination skills of practicing physicians.
  
  
  OBJECTIVE
  This study explored physical examination skills of 3rd-year medical students after completion of a course in physical diagnosis.
  
  
  METHODS
  Standardized patient physical examination checklist data were analyzed for a cohort of 2,038 medical students for a patient presenting with classic signs and symptoms of an acute myocardial infarction. A follow-up paper case and survey explored reasons underlying omissions.
  
  
  RESULTS
  Students systematically omitted 3 of 10 component maneuvers critical to the evaluation of a patient with shortness of breath and chest pain. The same pattern of omissions was observed across 8 medical schools and over 2 successive years. The paper case follow-up study ruled out time constraints and performance anxiety as the cause. Survey data revealed that students may omit a maneuver due to inability to recall pertinence (blood pressure in both arms) or difficulty discriminating findings (heart sounds at different locations), or because of inadequate technical mastery (percussion of the lungs).
  
  
  CONCLUSIONS
  These data suggest fundamental inadequacies in the current paradigm for teaching physical examination skills. Standardized patient checklist data can provide an informative window into the efficacy of teaching practices.
authors.affiliation: Division of General Medicine, Columbia University Health Sciences, New York, New York, USA. co6@columbia.edu
authors.forename: C
authors.initials: C
authors.lastname: Ortiz-Neu
authors.forename: C A
authors.initials: CA
authors.lastname: Walters
authors.forename: J
authors.initials: J
authors.lastname: Tenenbaum
authors.forename: J A
authors.initials: JA
authors.lastname: Colliver
authors.forename: H J
authors.initials: HJ
authors.lastname: Schmidt
mesh_terms: D002983:Clinical Competence; D015331:Cohort Studies; D004501:Education, Medical / Q000592:standards*; D006801:Humans; D009203:Myocardial Infarction / Q000175:diagnosis*; D010808:Physical Examination / Q000592:standards*