Abnormal findings in peers during skills learning.

Area of Science:

• Medical Education
• Clinical Skills Training
• Patient Safety

Background:

• Peer physical examination (PPE) is a common method for teaching clinical skills.
• Concerns exist regarding the identification and management of abnormal physical findings during PPE.
• Previous risk quantification for abnormal findings in PPE was limited to case studies and retrospective surveys.

Purpose of the Study:

• To prospectively quantify the incidence and types of abnormalities encountered during early clinical skills learning via PPE.
• To assess the feasibility of managing abnormal findings within a formal consent and event reporting process.

Main Methods:

• A prospective study was conducted on medical students in years 2 and 3 between 2003 and 2014.
• Data were collected through a formal written consent process for PPE, including the completion of event forms for abnormal findings.
• Analysis focused on the number and types of abnormalities reported.

Main Results:

• Nineteen event forms were completed over the study period (2003-2014).
• Annual incidence rates of abnormal findings ranged from 0.23% to 1.05%.
• Identified abnormalities included elevated blood pressure, heart murmurs, abnormal test values, and dermatological/ophthalmological conditions.

Conclusions:

• The low incidence rate of abnormalities suggests PPE is relatively safe concerning unexpected findings.
• A formal process for managing abnormalities, integrated into a written PPE policy, is recommended.
• While some abnormalities may be missed, the overall absolute rate remains low, providing reassurance.