TEACHING PHYSICAL-EXAMINATION OF THE ADULT LIVER WITH USE OF REAL-TIME SONOGRAPHY

Rationale and Objectives. The authors developed and evaluated an appro ach to teaching examination of the liver that incorporates real-time u ltrasound (US) imaging as immediate feedback to improve diagnostic acc uracy. Materials and Methods. Second-year medical students participati ng in a course in physical examination were assigned to receive instru ction in measuring liver span without (group 1) or with (group 2) real -time sonography. Students from each group attended a practice session given by one of two physicians who were board certified in radiology and internal medicine with special expertise in US. During the practic e session for group 2, students were shown the boundaries of the liver of the practice patient with real-time US. Both groups of students th en made three measurements each of the liver span of a healthy practic e patient and a single healthy test patient without US. The vertical l iver span reference standard was determined by one of the authors. Res ults. Students in group 2 showed greater accuracy in measuring liver s pan during both the practice and the test sessions than did students i n group 1. The differences were significant for the third practice mea surement and all three test measurements (P < .05). Conclusion. The us e of real-time US as an aid in teaching physical examination improves students' accuracy in measuring liver size.