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Physical Examination Education in Graduate Medical Education—A Systematic Review of the Literature

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ABSTRACT

OBJECTIVES

There is widespread recognition that physical examination (PE) should be taught in Graduate Medical Education (GME), but little is known regarding how to best teach PE to residents. Deliberate practice fosters expertise in other fields, but its utility in teaching PE is unknown. We systematically reviewed the literature to determine the effectiveness of methods to teach PE in GME, with attention to usage of deliberate practice.

DATA SOURCES

We searched PubMed, ERIC, and EMBASE for English language studies regarding PE education in GME published between January 1951 and December 2012.

STUDY ELIGIBILITY CRITERIA

Seven eligibility criteria were applied to studies of PE education: (1) English language; (2) subjects in GME; (3) description of study population; (4) description of intervention; (5) assessment of efficacy; (6) inclusion of control group; and (7) report of data analysis.

STUDY APPRAISAL AND SYNTHESIS METHODS

We extracted data regarding study quality, type of PE, study population, curricular features, use of deliberate practice, outcomes and assessment methods. Tabulated summaries of studies were reviewed for narrative synthesis.

RESULTS

Fourteen studies met inclusion criteria. The mean Medical Education Research Study Quality Instrument (MERSQI) score was 9.0 out of 18. Most studies (n = 8) included internal medicine residents. Half of the studies used resident interaction with a human examinee as the primary means of teaching PE. Three studies “definitely” and four studies “possibly” used deliberate practice; all but one of these studies demonstrated improved educational outcomes.

LIMITATIONS

We used a non-validated deliberate practice assessment. Given the heterogeneity of assessment modalities, we did not perform a meta-analysis.

CONCLUSIONS AND IMPLICATIONS OF KEY FINDINGS

No single strategy for teaching PE in GME is clearly superior to another. Following the principles of deliberate practice and interaction with human examinees may be beneficial in teaching PE; controlled studies including these educational features should be performed to investigate these exploratory findings.

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Acknowledgements

Contributors

The authors wish to thank Judy Maselli, MSPH for her assistance in the statistical analyses.

Funders

The Society of Directors of Research in Medical Education provided an honorarium to Dr. Mookherjee and Dr. Chou to support this work.

Prior presentations

This work was presented at the Society of Directors of Research in Medical Education (SDMRE) Summer Meeting: Annapolis, MD, June 17, 2012. Prior versions of this work were presented at the University of California at San Francisco Medical Education Day, April 25, 2011; Society of General Internal Medicine (SGIM) National Conference: Phoenix, AZ, May 4–7, 2011; and Western Group of Educational Affairs (WGEA) Regional Conference, Stanford School of Medicine, CA, April 30–May 3, 2011.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

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Authors and Affiliations

  1. Department of Medicine, Division of General Internal Medicine, University of Washington, Magnuson Health Sciences Center, Room B-503, Box 356429, Seattle, WA, 98195-6429, USA

    Somnath Mookherjee MD

  2. Columbia University, New York, USA

    Lara Pheatt MA

  3. Department of Medicine, Division of Hospital Medicine, University of California, San Francisco, USA

    Sumant R. Ranji MD

  4. Department of Medicine, Division of General Internal Medicine, University of California, San Francisco, USA

    Calvin L. Chou MD, PhD

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  1. Somnath Mookherjee MD
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Correspondence to Somnath Mookherjee MD.

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Mookherjee, S., Pheatt, L., Ranji, S.R. et al. Physical Examination Education in Graduate Medical Education—A Systematic Review of the Literature. J GEN INTERN MED 28, 1090–1099 (2013). https://doi.org/10.1007/s11606-013-2380-x

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