DEVELOPMENT, IMPLEMENTATION, AND EVALUATION OF AN ADVANCED PHYSICAL DIAGNOSIS COURSE FOR SENIOR MEDICAL-STUDENTS

Purpose. To develop, implement, and evaluate a new course curriculum d esigned to increase senior medical students' knowledge, psychomotor sk ills, interpretative abilities, and clinical utility regarding physica l examination techniques. Method. From February 1991 through February 1993, 53 fourth-year students at the Medical College of Wisconsin part icipated in a one-month elective, Advanced Physical Diagnosis (P;PD), which was taught by faculty members of the Division of General Interna l Medicine. The APD course included the following modules: (1) organ-s pecific didactic and interactive practice sessions; (2) physical-exami nation-based case conferences; and (3) professorial rounds, consisting of rounds on inpatient medical services and the use of professional p atients, i.e., outpatients with specific, incontrovertible physical fi ndings. An objective structured clinical examination (OSCE) was develo ped to evaluate the examination skills of the APD students. A pre- and post-course OSCE format was used with both the APD students and a con trol group of students rotating on the general medicine ward service. In addition, the APD students evaluated their own skills in physical e xamination and evaluated the course and each of its components by anon ymously completing an extensive end-of-course survey. Results. The pre -course OSCE detection rate of incontrovertible physical findings was similar between the control and APD students (Mantel-Haenszel X(2)=2.4 , p>.1); the post-course OSCE showed significant improvement in the de tection rates for the APD students compared with the control students (Mantel-Haenszel X(2)=45.8, p<.0001). The APD students felt strongly t hat the course had improved their physical examination skills and high ly recommended the elective to their colleagues. Conclusion. Both the OSCE results and the students' self-assessments indicate that the pilo t curriculum for the APD course improved the students' physical examin ation skills. The curriculum can be expanded and also exported to othe r institutions. Such a course may help promote and refine the use of p hysical diagnosis in the delivery of quality, timely, and cost-efficie nt health care.