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


METHODS
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.
Hatala
Rose
R
Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. rhatala@mac.com
Cole
Gary
G
Kassen
Barry O
BO
Bacchus
C Maria
CM
Issenberg
S Barry
SB
D001296:Audiovisual Aids; D002983:Clinical Competence; D004503:Education, Medical, Graduate; D006331:Heart Diseases / Q000175:diagnosis; D006801:Humans; D007388:Internal Medicine / Q000193:education; D008348:Manikins; D009422:Nervous System Diseases / Q000175:diagnosis; D010808:Physical Examination; D019095:Point-of-Care Systems