title: Junior doctor skill in the art of physical examination: a retrospective study of the medical admission note over four decades.
abstract: OBJECTIVE
  To investigate the hypothesis that junior doctors' examination skills are deteriorating by assessing the medical admission note examination record.
  
  
  METHODS
  Retrospective study of the admission record.
  
  
  METHODS
  Tertiary care hospital.
  
  
  METHODS
  The admission records of 266 patients admitted to Wellington hospital between 1975 and 2011 were analysed, according to the total number of physical examination observations (PEOtot), examination of the relevant system pertaining to the presenting complaint (RelSystem) and the number of body systems examined (Nsystems). Subgroup analysis proceeded according to admission year, level of experience of the admitting doctor (registrar, house surgeon (HS) and trainee intern (TI)) and medical versus surgical admission notes. Further analysis investigated the trend over time in documentation with respect to cardiac murmurs, palpable liver, palpable spleen, carotid bruit, heart rate, funduscopy and apex beat location and character.
  
  
  RESULTS
  PEOtot declined by 34% from 1975 to 2011. Surgical admission notes had 21% fewer observations than medical notes. RelSystem occurred in 94% of admissions, with no decline over time. Medical notes documented this more frequently than surgical notes (98% and 86%, respectively). There were no differences between registrars and HS, except for the 2010s subgroup (97% and 65%, respectively). Nsystems declined over the study period. Medical admission notes documented more body systems than surgical notes. There were no differences between registrars, HSs and TIs. Fewer examinations were performed for palpable liver, palpable spleen, cardiac murmur and apex beat location and character over the study period. There was no temporal change in the positive findings of these observations or heart rate rounding.
  
  
  CONCLUSIONS
  There has been a decline in the admission record at Wellington hospital between 1975 and 2011, implying a deterioration in local doctors' physical examination skills. Measures to counter this trend are discussed.
authors.affiliation: School of Medicine and Health Sciences, University of Otago Wellington, Wellington, New Zealand.
authors.forename: Charlotte M
authors.initials: CM
authors.lastname: Oliver
authors.forename: Selena A
authors.initials: SA
authors.lastname: Hunter
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Ikeda
authors.forename: Duncan C
authors.initials: DC
authors.lastname: Galletly
references.citation: Arch Intern Med. 2008 Aug 11;168(15):1692-8
references.pmid: 18695085
references.citation: Ann Intern Med. 1997 Feb 1;126(3):217-20
references.pmid: 9027273
references.citation: Acad Med. 2005 Mar;80(3):302-8
references.pmid: 15734818
references.citation: Acad Med. 2008 Mar;83(3):257-64
references.pmid: 18316871
references.citation: J Gen Intern Med. 1996 Aug;11(8):490-3
references.pmid: 8872788
references.citation: JAMA. 1985 Jul 5;254(1):70-6
references.pmid: 3999353
references.citation: CMAJ. 1988 Oct 1;139(7):629-32
references.pmid: 3416264
references.citation: J Hosp Med. 2009 May;4(5):304-7
references.pmid: 19504491
references.citation: Lancet. 2003 Oct 4;362(9390):1100-5
references.pmid: 14550696
references.citation: Acad Psychiatry. 2004 Summer;28(2):136-9
references.pmid: 15298866
references.citation: AMIA Annu Symp Proc. 2008 Nov 06;:156-60
references.pmid: 18999303
references.citation: Accid Emerg Nurs. 2005 Oct;13(4):247-50
references.pmid: 16199165
references.citation: Ambul Pediatr. 2005 Jul-Aug;5(4):253-7
references.pmid: 16026193
references.citation: Circulation. 1996 Mar 15;93(6):1250-3
references.pmid: 8653848
references.citation: Am J Surg. 2010 Jun;199(6):817-22
references.pmid: 20609725
references.citation: West J Med. 1992 Feb;156(2):163-5
references.pmid: 1536065
references.citation: Br Med J. 1975 May 31;2(5969):486-9
references.pmid: 1148666
references.citation: Arch Intern Med. 1994 Jan 10;154(1):22-4
references.pmid: 8267485
references.citation: N Engl J Med. 1988 Jun 16;318(24):1572-8
references.pmid: 2897627
references.citation: Ann R Coll Surg Engl. 2002 Mar;84(2):122-4
references.pmid: 11995752
references.citation: Curr Probl Cardiol. 1995 Jul;20(7):441-530
references.pmid: 7555039
references.citation: Int J Qual Health Care. 1996 Dec;8(6):537-42
references.pmid: 9007603
references.citation: Am J Med. 2003 Feb 15;114(3):211-6
references.pmid: 12641082
references.citation: Nurs Adm Q. 2003 Oct-Dec;27(4):285-9
references.pmid: 14649019
references.citation: Ann Emerg Med. 1991 Jun;20(6):641-3
references.pmid: 2039102