Assessing the relationship between cardiac physical examination technique and accurate bedside diagnosis during an objective structured clinical examination (OSCE).
BACKGROUND
Many standardized patient (SP) encounters employ SPs without physical findings and, thus, assess physical examination technique. The relationship between technique, accurate bedside diagnosis, and global competence in physical examination remains unclear.


METHODS
Twenty-eight internists undertook a cardiac physical examination objective structured clinical examination, using three modalities: real cardiac patients (RP), "normal" SPs combined with related cardiac audio-video simulations, and a cardiology patient simulator (CPS). Two examiners assessed physical examination technique and global bedside competence. Accuracy of cardiac diagnosis was scored separately.


RESULTS
The correlation coefficients between participants' physical examination technique and diagnostic accuracy were 0.39 for RP (P < .05), 0.29 for SP, and 0.30 for CPS. Patient modality impacted the relative weighting of technique and diagnostic accuracy in the determination of global competence.


CONCLUSIONS
Assessments of physical examination competence should evaluate both technique and diagnostic accuracy. Patient modality affects the relative contributions of each outcome towards a global rating.
Hatala
Rose
R
St. Paul's Hospital, 1081 Burrard St., Vancouver, BC, Canada, V6Z 1Y6. rhatala@mac.com
Issenberg
S Barry
SB
Kassen
Barry O
BO
Cole
Gary
G
Bacchus
C Maria
CM
Scalese
Ross J
RJ
D001955:British Columbia; D002309:Cardiology / Q000193:education*; D002983:Clinical Competence; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007396:Internship and Residency / Q000379:methods*; D010808:Physical Examination / Q000379:methods*; D019095:Point-of-Care Systems / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012577:Schools, Medical