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

Abstract

Aim: 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.

Method: 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.

Additional information

Notes on contributors

Rose Hatala

DR. HATALA is a general internist and clinical associate professor, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. She is an Examination Board member for the RCPSC Comprehensive Objective Examination in Internal Medicine.

Gary ColE

DR. COLE is a senior research associate and manager of the Educational Research and Development Unit, RCPSC, Ottawa, Ontario, Canada.

Barry O. Kassen

DR. KASSEN is a general internist and clinical associate professor, Department of Medicine, University of British Columbia Faculty of Medicine, Vancouver, British Columbia, Canada. He is the Chair of the Examination Board for the RCPSC Comprehensive Objective Examination in Internal Medicine.

C. Maria Bacchus

DR. BACCHUS is a general internist and associate professor, Department of Medicine, University of Calgary Faculty of Medicine, Calgary, Alberta, Canada. She is the Chair of the Oral Examination for the RCPSC Comprehensive Objective Examination in Internal Medicine.

S. Barry Issenberg

DR. ISSENBERG is a general internist and associate professor, an Assistant Dean for Research in Medical Education, and the Director of Educational Research and Technology at the Gordon Center for Research in Medical Education, University of Miami Miller School of Medicine, Miami, Florida.