CREATION AND ASSESSMENT OF A STRUCTURED REVIEW COURSE IN PHYSICAL DIAGNOSIS FOR MEDICAL RESIDENTS

Objective: To evaluate the effects of a course in physical diagnosis o n the knowledge, skills, and attitudes of internal medicine trainees. Design: A controlled, prospective assignment of housestaff to a year-l ong curricular program, linked to a set of pre- and posttests. House-o fficers who could not attend the teaching sessions functioned as contr ol subjects. Setting: An internal medicine training program at an urba n medical school. Subjects: 56 (86.1%) of 65 eligible internal medicin e housestaff (post-graduate years 1 through 3) participated in the int ervention and assessment. A comparison group of 14 senior medical stud ents participated in the pretest. Intervention: 12 monthly lectures em phasizing skills useful in emergencies or validated by the literature. Measurements: The pre- and posttests included: 1) a multiple-choice q uestionnaire to assess knowledge; 2) professional standardized patient s to assess selected skills; and 3) Likert-type questionnaires to asse ss self-motivated learning and attitude toward diagnosis not based on technology. Main results: The residents expressed interest in the prog ram and on a six-point scale rated the usefulness of lectures and stan dardized patients as 3.5 +/- 1.3 and 4.3 +/- 1, respectively. For no s ystem tested, however, did they achieve more than 55.2% correct answer s (range: 24.2% - 55.2%, median = 41.04), and their performance did no t differ from that of the fourth-year medical students. There was no s ignificant difference in pre/posttest improvement between the control and intervention groups. Conclusions: These data confirm the deficienc ies of physical diagnostic skills and knowledge among physicians in tr aining. These deficiencies were not corrected by the classroom lecture series. Improvement in these skills may require a more intense experi ential program made part of residency requirements.