BMC Medical Education (Oct 2017)

A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training

  • Brian Thomas Garibaldi,
  • Timothy Niessen,
  • Allan Charles Gelber,
  • Bennett Clark,
  • Yizhen Lee,
  • Jose Alejandro Madrazo,
  • Reza Sedighi Manesh,
  • Ariella Apfel,
  • Brandyn D. Lau,
  • Gigi Liu,
  • Jenna VanLiere Canzoniero,
  • C. John Sperati,
  • Hsin-Chieh Yeh,
  • Daniel J. Brotman,
  • Thomas A. Traill,
  • Danelle Cayea,
  • Samuel C. Durso,
  • Rosalyn W. Stewart,
  • Mary C. Corretti,
  • Edward K. Kasper,
  • Sanjay V. Desai

DOI
https://doi.org/10.1186/s12909-017-1020-2
Journal volume & issue
Vol. 17, no. 1
pp. 1 – 11

Abstract

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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.

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