Fourth-year medical students do not perform a focused physical examination during a case-based simulation scenario

Area of Science:

• Medical Education
• Clinical Skills Assessment
• Simulation-Based Learning

Background:

• Physical examination proficiency is crucial for medical students but has shown a decline.
• Simulation-based training is a promising method to enhance physical examination skills.
• This study evaluated a cardiac case simulation to assess fourth-year medical students' physical examination performance during an emergency medicine (EM) clerkship.

Purpose of the Study:

• To determine the utility of a cardiac case-based simulation scenario.
• To assess the physical examination performance of fourth-year medical students.
• To identify areas for improvement in physical examination training within EM clerkships.

Main Methods:

• Fourth-year medical students underwent a cardiac arrest simulation using a Laerdal SimMan mannequin.
• Simulations were video-recorded and reviewed by two emergency physicians.
• Essential components of a focused physical examination were assessed for completion.

Main Results:

• Twenty-seven students participated, with low completion rates for key examination components.
• Cardiac auscultation: 33.3%, lung auscultation: 29.6%, pulse/extremity exam: 55.6%, abdominal exam: 3.7%.
• No student completed all four essential physical examination components.

Conclusions:

• Fourth-year medical students demonstrated inconsistent performance of focused physical examinations during a high-acuity simulation.
• Simulation provides a platform for observation, feedback, and skill improvement in physical examination.
• Enhanced simulation technology and faculty development are needed for effective integration of physical examination skills into high-acuity scenarios.