Development, implementation, and evaluation of an advanced physical diagnosis course for senior medical students

To develop, implement, and evaluate a new course curriculum designed to increase senior medical students' knowledge, psychomotor skills, interpretative abilities, and clinical utility regarding physical examination techniques.

From February 1991 through February 1993, 53 fourth-year students at the Medical College of Wisconsin participated in a one-month elective, Advanced Physical Diagnosis (APD), which was taught by faculty members of the Division of General Internal Medicine. The APD course included the following modules: (1) organ-specific didactic and interactive practice sessions; (2) physical-examination-based case conferences; and (3) professorial rounds, consisting of rounds on inpatient medical services and the use of professional patients, i.e., outpatients with specific, incontrovertible physical findings. An objective structured clinical examination (OSCE) was developed to evaluate the examination skills of the APD students. A pre- and post-course OSCE format was used with both the APD students and a control group of students rotating on the general medicine ward service. In addition, the APD students evaluated their own skills in physical examination and evaluated the course and each of its components by anonymously completing an extensive end-of-course survey.

The pre-course OSCE detection rate of incontrovertible physical findings was similar between the control and APD students (Mantel-Haenszel chi 2 = 2.4, p > .1); the post-course OSCE showed significant improvement in the detection rates for the APD students compared with the control students (Mantel-Haenszel chi 2 = 45.8, p < .0001). The APD students felt strongly that the course had improved their physical examination skills and highly recommended the elective to their colleagues.

Both the OSCE results and the students' self-assessments indicate that the pilot curriculum for the APD course improved the students' physical examination skills. The curriculum can be expanded and also exported to other institutions. Such a course may help promote and refine the use of physical diagnosis in the delivery of quality, timely, and cost-efficient health care.