A core physical exam for medical students: results of a national survey.

PURPOSE: Medical students are traditionally taught the physical exam as a comprehensive battery of maneuvers, yet they express uncertainty about which maneuvers are "core" and should be performed routinely on patients and which ones should be performed only when clinically indicated. The authors sought to determine whether educator consensus existed on the concept and the specifics of a core physical exam for students. METHOD: The authors developed a 45-maneuver core physical exam to be performed by a medicine clerkship student on every newly admitted patient, with the expectation that it would be supplemented by clinically indicated additional maneuvers. From 2011 to 2012 they sent surveys to physical diagnosis course directors (PDCDs) and internal medicine clerkship directors (IMCDs) from all 132 U.S. allopathic medical schools to determine the extent of their agreement with the proposed 45 maneuvers and their opinions about the concept of a core exam. RESULTS: Seventy-one percent (94/132) of PDCDs and 63% (83/132) of IMCDs responded to the survey. In total, 84% (111/132) of all schools surveyed were represented by either their PDCD or IMCD. Of the 45 proposed maneuvers, 37 were deemed "core" by a majority of respondents. The majority of IMCDs preferred a slightly leaner 37-maneuver core exam than the majority of PDCDs, who voted for 41 maneuvers. CONCLUSIONS: Among PDCDs and IMCDs, there was openness to teaching medical students a streamlined core physical exam to which other maneuvers are added as clinically indicated. These educators closely agreed on the maneuvers this core exam should include.

Long-term retention of smoking cessation counseling skills learned in the first year of medical school.

BACKGROUND: Tobacco use is a significant cause of preventable morbidity and mortality in the United States, yet clinicians underutilize smoking cessation counseling. Medical schools are increasingly including training for smoking cessation skills in preclinical curricula. Information about long-term retention of these skills is needed. OBJECTIVE: To assess retention of smoking cessation counseling skills learned in the first year of medical school. DESIGN: Retrospective review of data collected for routine student and curriculum assessment. PARTICIPANTS: Two cohorts of medical students at the University of Connecticut School of Medicine (total N = 112) in 1999-2001 and 2002-2004. MEASUREMENTS AND MAIN RESULTS: Scores by standardized patients were compared from first and fourth-year assessments, based on checklist items corresponding to the 5 strategies recommended by the U.S. Public Health Service (Ask, Advise, Assess, Assist, Arrange). In study cases, 97% of first-year students "asked" about smoking and retained this skill in fourth year (p = .08). Ninety-four percent of first-year students "assessed" readiness to quit and retained this skill (p = .21). Ninety-six percent of first-year students "advised" smokers to quit and retained this skill (p = .18). Eighty-six percent of first year students "assisted" smokers in quitting and retained this skill (p = 0.10). Eighty-one percent of first year students "arranged" follow-up contact and performance of this strategy improved in the fourth year to 91% (p = .03). CONCLUSIONS: Smoking cessation counseling skills demonstrated by first year medical students were, with brief formal reinforcement in the third year, well retained into the fourth year of medical school. It is appropriate to begin this training early in medical education.

Face-to-face clinical skills feedback: lessons from the analysis of standardized patient's work.

BACKGROUND: Current evidence suggests that trainees are evaluated less stringently when feedback is given face-to-face, limiting its value. PURPOSE: We expected that standardized patients (SPs) would also be more lenient in scoring when they gave immediate feedback to the students. METHODS: Data from 6 clinical skills assessments of students in Years 1 to 4 of medical school were used. Comparisons in scoring were made for the cases on which students received feedback and those where they did not. Analysis was done using a hierarchical linear regression model to test for significant differences. RESULTS: The results indicated no significant difference in scoring for the history and physical exam checklists. There was a small but significant difference on the measure of interpersonal and interviewing skills. CONCLUSIONS: The SPs were trained to avoid stringency, leniency, and restricted range in scoring students. These training methods may be useful for training faculty to give face-to-face feedback.