USING CHART REVIEWS TO ASSESS RESIDENTS PERFORMANCES OF COMPONENTS OFPHYSICAL-EXAMINATIONS - A PILOT-STUDY

Purpose. To evaluate chart review as a method of assessing residents' performances of physical examinations in an ambulatory care setting. M ethod. In 1992, nurse authors at the Affiliated Hospitals at Canton of the Northeastern Ohio Universities College of Medicine assessed wheth er 22 internal medicine residents performed ten components of the phys ical examination by interviewing patient volunteers immediately after the patients' examinations. A total of 89 patient interviewees were in cluded in the analysis; these patients were all new outpatients who ha d been scheduled for initial visits to obtain complete histories and p hysical examinations. Charts for the same patients were then retrospec tively reviewed. The residents and faculty were blinded to both the ch art reviews and the interviews. Statistical methods used were Pearson correlational anal is and variance-component analysis. Results. The in terviews and chart reviews showed 81% agreement in component performan ce. Completeness of the physical examination (whether measured by char t review or interview) did not correlate with other standard methods o f resident evaluation, and completeness did not show a significant ass ociation with characteristics of the residents and patients. Two of th e 22 residents assessed were identified as having completeness scores so low as to be unsatisfactory. Conclusion. That residents were identi fied as failing to perform examination components suggests that chart reviews, especially when independently verified by patient interviews, may be a useful evaluation tool for identifying inadequate performanc e of components of the physical examination and may identify the need for remediation.