Student performance of the general physical examination in internal medicine: an observational study.
Student performance of the general physical examination in internal medicine: an observational study.
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DOI：
10.1186/1472-6920-14-73
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发表时间：
2014-04-08
影响因子：
3.6
通讯作者：
Postma CT
中科院分区：
文献类型：
--
作者：
Haring CM;Cools BM;van der Meer JW;Postma CT
许多执业医师缺乏体检技能。目前尚不清楚在早期临床训练后，体检技能是否已经显示出缺陷。在内科实习结束时，学生应该能够对每一个新病人进行全面的身体检查。在以往的研究中，基本体检项目的标准执行是通过协商一致确定的。本观察性研究的目的是评估医学生在内科实习结束时是否能够正确地进行全面体检，包括完整性和技术。100名刚刚完成内科学见习的学生被要求对一名标准化的病人进行全面的身体检查，这是他们在见习期间所学到的。他们被摄像机录了下来。统计体格检查各组成部分的表现频率。使用每个体检组成部分的简短描述清单来确定表现的充分性是否正确或不正确或不可评估。通过计算三名训练有素的医生评定的五项体检总分的班级内相关系数，以及他们对所有项目的表现的一致性，进行了信度分析。约40%的约定标准体检项目没有由学生进行。学生们最重视的是一般参数、心、肺和腹部的检查。身体检查的许多组成部分没有按照预科课上教的那样进行。体检总分0.91 （p <0.001）和五项体检成绩一致性（0.79-0.92 p <0.001）的班级内相关性较高。综上所述，在内科实习结束时，普通体检的表现已经低于预期。讨论了可能的原因和改进建议。
Many practicing physicians lack skills in physical examination. It is not known whether physical examination skills already show deficiencies after an early phase of clinical training. At the end of the internal medicine clerkship students are expected to be able to perform a general physical examination in every new patient encounter. In a previous study, the basic physical examination items that should standardly be performed were set by consensus. The aim of the current observational study was to assess whether medical students were able to correctly perform a general physical examination regarding completeness as well as technique at the end of the clerkship internal medicine. One hundred students who had just finished their clerkship internal medicine were asked to perform a general physical examination on a standardized patient as they had learned during the clerkship. They were recorded on camera. Frequency of performance of each component of the physical examination was counted. Adequacy of performance was determined as either correct or incorrect or not assessable using a checklist of short descriptions of each physical examination component. A reliability analysis was performed by calculation of the intra class correlation coefficient for total scores of five physical examinations rated by three trained physicians and for their agreement on performance of all items. Approximately 40% of the agreed standard physical examination items were not performed by the students. Students put the most emphasis on examination of general parameters, heart, lungs and abdomen. Many components of the physical examination were not performed as was taught during precourses. Intra-class correlation was high for total scores of the physical examinations 0.91 (p <0.001) and for agreement on performance of the five physical examinations (0.79-0.92 p <0.001). In conclusion, performance of the general physical examination was already below expectation at the end of the internal medicine clerkship. Possible causes and suggestions for improvement are discussed.
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影响因子：
5.7
作者：
McMahon, GT;Marina, O;Katz, JT
通讯作者：
Katz, JT
影响因子：
168.9
作者：
Reilly, BM
通讯作者：
Reilly, BM
影响因子：
7.4
作者：
LI, JTC
通讯作者：
LI, JTC
影响因子：
7.4
作者：
KOPELOW, ML;SCHNABL, GK;GROTT, M
通讯作者：
GROTT, M
影响因子：
7.4
作者：
Howley, LD;Wilson, WG
通讯作者：
Wilson, WG