Using Objective Structured Clinical Examinations to Assess Intern Orthopaedic Physical Examination Skills: A Multimodal Didactic Comparison

Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teac...

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Bibliographic Details
Published in:Journal of surgical education 2017-05, Vol.74 (3), p.513-518
Main Authors: Phillips, Donna, MD, Pean, Christian A., MD, MS, Allen, Kathleen, BS, Zuckerman, Joseph, MD, Egol, Kenneth, MD
Format: Article
Language:English
Subjects:
Academic Medical Centers
Adult
Clinical Competence
Cohort Studies
Curriculum
Education, Medical, Graduate - methods
Female
Humans
Internship and Residency - organization & administration
Male
Medical Knowledge
near-peer
New York City
orthopedics
Orthopedics - education
OSCE
Patient Care
physical examination
Physical Examination - methods
Physical Examination - standards
Practice-Based Learning and Improvement
Program Evaluation
Prospective Studies
residency training
Surgery
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Summary:Patient care is 1 of the 6 core competencies defined by the Accreditation Council for Graduate Medical Education (ACGME). The physical examination (PE) is a fundamental skill to evaluate patients and make an accurate diagnosis. The purpose of this study was to investigate 3 different methods to teach PE skills and to assess the ability to do a complete PE in a simulated patient encounter. Design Prospective, uncontrolled, observational. Setting Northeastern academic medical center. Participants A total of 32 orthopedic surgery residents participated and were divided into 3 didactic groups: Group 1 ( n = 12) live interactive lectures, demonstration on standardized patients, and textbook reading; Group 2 ( n = 11) video recordings of the lectures given to Group 1 and textbook reading alone; Group 3 ( n = 9): 90-minute modules taught by residents to interns in near-peer format and textbook reading. Results The overall score for objective structured clinical examinations from the combined groups was 66%. There was a trend toward more complete PEs in Group 1 taught via live lectures and demonstrations compared to Group 2 that relied on video recording. Near-peer taught residents from Group 3 significantly outperformed Group 2 residents overall (p = 0.02), and trended toward significantly outperforming Group 1 residents as well, with significantly higher scores in the ankle (p = 0.02) and shoulder (p = 0.02) PE cases. Conclusions This study found that orthopedic interns taught musculoskeletal PE skills by near-peers outperformed other groups overall. An overall score of 66% for the combined didactic groups suggests a baseline deficit in first-year resident musculoskeletal PE skills. The PE should continue to be taught and objectively assessed throughout residency to confirm that budding surgeons have mastered these fundamental skills before going into practice.
ISSN:1931-7204
1878-7452
DOI:10.1016/j.jsurg.2016.10.011