A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

作者：Garibaldi Brian Thomas^*; Niessen Timothy; Gelber Allan Charles; Clark Bennett; Lee Yizhen; Madrazo Jose Alejandro; Manesh Reza Sedighi; Apfel Ariella; Lau Brandyn D; Liu Gigi; Canzoniero Jenna VanLiere; Sperati C John; Yeh Hsin Chieh; Brotman Daniel J; Traill Thomas A; Cayea Danelle; Durso Samuel C; Stewart Rosalyn W; Corretti Mary C; Kasper Edward K; Desai Sanjay V

来源：BMC Medical Education, 2017, 17(1): 182.

DOI：10.1186/s12909-017-1020-2

• Medical education
• Physical examination skills
• Cardiopulmonary exam
• Bedside medicine

Background: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill.
Methods: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE).
Results: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE.
Conclusions: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

• 出版日期2017-10-6