ABSTRACT
BACKGROUND: Physicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill. METHODS: One hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE). RESULTS: Interns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE. CONCLUSIONS: A comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.
Subject(s)
Clinical Competence/standards , Diagnostic Techniques, Cardiovascular , Education, Medical, Graduate , Internal Medicine/education , Physical Examination , Point-of-Care Testing , Adult , Curriculum , Diagnostic Techniques, Cardiovascular/standards , Educational Measurement , Humans , Physical Examination/standardsABSTRACT
BACKGROUND: Outside of the newborn period, development of gonococcal conjunctivitis is rare and predominantly occurs through autoinoculation. We report an unusual case of gonococcal conjunctivitis in a young woman exposed through direct inoculation. CASE: A 19-year-old woman presented with purulent ocular discharge, severe pain, and decreased vision unresponsive to topical antibiotics or ganciclovir approximately 3 weeks after accidental ocular exposure to seminal fluid during unprotected oral sex. Cultured ocular drainage grew Neisseria gonorrhea; vaginal and throat cultures were negative. She was successfully treated with ceftriaxone and doxycycline for 10 days. SUMMARY AND CONCLUSION: Clinicians should be aware of the potential for vision-threatening gonococcal conjunctivitis from exposure during sexual contact.
Subject(s)
Anti-Bacterial Agents/therapeutic use , Conjunctivitis, Bacterial/diagnosis , Gonorrhea/diagnosis , Neisseria gonorrhoeae/isolation & purification , Sexual Behavior , Adult , Conjunctivitis, Bacterial/drug therapy , Female , Gonorrhea/drug therapy , Gonorrhea/transmission , Humans , Infant, Newborn , Unsafe SexABSTRACT
To prevent death, necrotizing soft-tissue infections should be diagnosed quickly and treated with broad-spectrum antibiotics and surgical debridement.
