PHYSICAL DIAGNOSIS SKILLS OF PHYSICIANS IN-TRAINING - A FOCUSED ASSESSMENT

Objective: To assess the proficiency of emergency medicine (EM) traine es in the recognition of physical findings pertinent to the care of th e critically ill patient. Methods: Fourteen medical students, 63 inter nal medicine (IM) residents, and 47 EM residents from three university -affiliated programs in Philadelphia were tested. Proficiency in physi cal diagnosis was assessed by a multimedia questionnaire targeting fin dings useful in emergencies or related to diseases frequently encounte red in the ED. Attitudes toward diagnosis not based on technology, tea ching practices of physical examination during EM training, and self-m otivated learning of physical diagnosis also were assessed for all the EM trainees. Results: With the exception of ophthalmology, the EM tra inees were never significantly better than the senior students or the IM residents. They were less proficient than the IM residents in cardi ology, and not significantly different from the IM residents in all ot her areas. For no organ system tested, however, did they achieve less than a 42.9% error rate (range: 42.9-72.3%, median = 54.8%). There was no significant improvement in proficiency over the three years of cus tomary EM training. The EM residents who had received supervised teach ing in physical diagnosis during training achieved a significantly hig her cumulative score. The EM residents attributed great clinical impor tance to physical diagnosis and wished for more time devoted to its te aching. Conclusions: These data confirm the recently reported deficien cies of physical diagnosis skills among physicians in training. The re sults are particularly disturbing because they relate to EM trainees a nd concern skills useful in the ED. Physical diagnosis should gain mor e attention in both medical schools and residency programs.