Assessing cardiac physical examination skills using simulation technology and real patients: a comparison study

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Cardiology

Background:

• High-stakes assessments of physical examination skills often use standardized patients (SPs) lacking physical abnormalities.
• Simulation technology offers a way to mimic physical abnormalities for skills assessment.

Purpose of the Study:

• To examine the relationship between internists' cardiac physical examination competence assessed via simulation technology versus real patients (RPs).

Main Methods:

• 28 internists' cardiac physical examination skills and diagnostic accuracy were assessed using an objective structured clinical examination (OSCE).
• Three modalities were used: RPs with abnormalities, SPs with computer-based simulations, and a cardiac patient simulator (CPS) manikin.
• Examiners rated physical examination technique and global clinical competence; investigators scored diagnostic accuracy.

Main Results:

• Inter-rater reliability for global ratings ranged from 0.75-0.78 across modalities.
• No significant difference in mean global ratings was found between modalities.
• Correlations between performances were low to modest: RP vs. SP (r=0.19), RP vs. CPS (r=0.22), SP vs. CPS (r=0.57).

Conclusions:

• Methodological limitations included variability in assessment components and a lack of objective outcome measures.
• No single modality served as a clear gold standard for assessing cardiac physical examination competence.
• Further research is needed to determine the optimal patient modality for high-stakes assessments.