title: Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison.
abstract: Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter.
  
  
  METHODS
  Prospective, uncontrolled, observational.
  
  
  METHODS
  Northeastern academic medical center.
  
  
  METHODS
  A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 (n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 (n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 (n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading.
  
  
  RESULTS
  The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases.
  
  
  CONCLUSIONS
  This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice.
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York. Electronic address: donna.phillips@nyumc.org.
authors.forename: Donna
authors.initials: D
authors.lastname: Phillips
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
authors.forename: Christian A
authors.initials: CA
authors.lastname: Pean
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
authors.forename: Kathleen
authors.initials: K
authors.lastname: Allen
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
authors.forename: Joseph
authors.initials: J
authors.lastname: Zuckerman
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, NYU School of Medicine, New York, New York.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Egol
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D002983:Clinical Competence; D015331:Cohort Studies; D003479:Curriculum; D004503:Education, Medical, Graduate / Q000379:methods*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000458:organization & administration*; D008297:Male; D009519:New York City; D009985:Orthopedics / Q000193:education*; D010808:Physical Examination / Q000379:methods / Q000592:standards*; D015397:Program Evaluation; D011446:Prospective Studies
keywords: Medical Knowledge; OSCE; Patient Care; Practice-Based Learning and Improvement; near-peer; orthopedics; physical examination; residency training