ASSESSMENT OF BASIC PHYSICAL-EXAMINATION SKILLS OF INTERNAL-MEDICINE RESIDENTS
ASSESSMENT OF BASIC PHYSICAL-EXAMINATION SKILLS OF INTERNAL-MEDICINE RESIDENTS
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DOI：
10.1097/00001888-199404000-00013
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发表时间：
1994-04-01
影响因子：
7.4
通讯作者：
LI, JTC
中科院分区：
文献类型：
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作者：
LI, JTC
背景马约诊所的内科医生设计了一个临床评估练习，将体检技能的评估与医学面试和推理技能的评估分开。本报告总结了第一年的经验与评估的基本体检技能。法由五名普通内科医生和三名内科专家组成的核心教师设计了一份45项普通检查清单（例如，测量血压、检查口腔、触诊肝脏、铺巾以确保隐私）。此外，核心教师还生成了一个包含27项重点考试技能的菜单（例如，检查腕管综合症），其中教员检查员将选择五个项目供住院医师执行。每个检查表项目的评分为0、1或2，最高评分为100分。核心教师选择了一个基于标准的评分参考，并建立了一个通过分数为90的基础上与居民和教师的实践考试。核心教员制作了一盘示范考试的教学录像带，供所有居民使用。在一九九一至九二年度，在进行考试前，我们已把这份核对表分发给所有第一年的分类住院医生（43名）、初步住院医生（25名）和新委任的第二年住院医生（8名）。结果在76名接受检查的居民中，11名（14%）不合格，65名（86%）合格。所有不及格分数均为86分或更低。87、88和89分的缺失表明教师提高了边缘表现。所有11名最初没有通过考试的居民都重新参加了考试并通过了考试。最常遗漏的五项是（1）检查皮肤，（2）按逻辑顺序进行全面检查，（3）触诊主动脉，（4）听诊前呼吸音，（5）触诊腋窝和腹股沟淋巴结。观察到的其他重要错误包括未能测量生命体征、肝脏和脾脏混淆、未能使用听诊器上的铃和乳房检查不充分。28名居民填写了一份可选的反馈表。评论褒贬不一，但总体上是有利的。结论对内科住院医生的基本体格检查技能进行评估是有用的，这些技能可以与体格诊断技能和面试技能分开评估。对基本体检技能的直接观察揭示了重要的缺陷，这为补救提供了机会。
Background. Internal medicine faculty at the Mayo Clinic designed a clinical evaluation exercise that separates assessment of physical examination skills from that of medical interviewing and reasoning skills. This report summarizes the first year's experience with assessment of basic physical examination skills. Method. A core faculty of five general internists and three internist subspecialists designed a 45-item general examination checklist (e.g., measure blood pressure, examine mouth, palpate liver, drape to ensure privacy). In addition, the core faculty generated a menu of 27 focused examination skills (e.g., examine for carpal tunnel syndrome) from which the faculty examiner would select five items for the resident to perform. Each checklist item was scored 0, 1, or 2 for a maximum possible score of 100. The core faculty selected a criterion-based scoring reference and established a passing score of 90 based on practice examinations with residents and faculty. The core faculty made an instructional videotape of a model examination that was available to all residents. In 1991-92, prior to examination, the checklist was distributed to all first-year categorical (43), preliminary (25), and newly appointed second-year residents (eight). Results. Of the 76 residents examined, 11 (14%) failed and 65 (86%) passed. All failing scores were 86 or lower. The absence of scores 87, 88, and 89 suggested that faculty upgraded borderline performances. All 11 residents who initially failed retook the examination and passed. The five most commonly missed items were (1) inspect the skin, (2) complete examination in logical sequence, (3) palpate aorta, (4) auscultate anterior breath sounds, and (5) palpate axillary and inguinal nodes. Other important observed errors were failure to measure vital signs, confusion of liver and spleen, failure to use bell on stethoscope, and inadequate breast examination. Twenty-eight residents completed an optional feedback form. Reviews were mixed but generally favorable. Conclusion. Assessment of the basic physical examination skills of the internal medicine residents was useful, and such skills were able to be assessed separately from physical diagnosis skills and interviewing skills. Direct observation of basic physical examination skills revealed important deficiencies, which provided opportunity for remediation.