Internal medicine intern performance on the gastrointestinal physical exam
Julia R Gips1, Ariella Apfel Stein2, Joyce Luckin1
1Department of Medicine, Baltimore, USA.
Diagnosis (Berlin, Germany)
|July 21, 2023
Summary
Internal medicine interns often struggle with gastrointestinal physical exam skills, impacting their ability to identify key findings. Structured training is recommended to improve their performance and diagnostic accuracy.
Area of Science:
- Medical Education
- Gastroenterology
- Clinical Skills Assessment
Background:
- The gastrointestinal (GI) physical exam is crucial for diagnosing diseases.
- Internal medicine residency programs rarely assess GI physical exam skills, leaving a gap in understanding resident competency.
Purpose of the Study:
- To evaluate the performance of internal medicine interns on the GI physical exam.
- To determine the correlation between physical exam technique, identification of findings, and differential diagnosis formulation.
Main Methods:
- A skills assessment was conducted with internal medicine interns examining a standardized patient with chronic liver disease.
- Faculty preceptors observed and compared performed maneuvers against expected standards, noting errors and missed findings.
- The study analyzed the association between exam technique, finding identification, and differential diagnosis accuracy.
Main Results:
- Over half of the interns (58.6%) scored "needs improvement" in physical exam technique.
- Exam technique strongly correlated with identifying correct physical signs (r=0.88, p<0.0001).
- Assessing for splenomegaly and hepatomegaly were the most common omitted maneuvers and missed findings.
Conclusions:
- Internal medicine interns require enhanced training in a structured approach to the GI physical exam.
- Improved training is expected to increase the identification of significant GI findings.
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