POSTER

Observed History and Physical Exam

Authors: Angelilli, M.L., Friday, Y.M.., Shy, R.., Wayne State University School of Medicine, Carman and Anne Adams Department of Pediatrics, Detroit, MI.

Objectives: 1. To assess the accuracy of a student's skill in performing a history and physical exam. 2. To provide immediate feedback regarding the expected level of performance.

Methods: Faculty and senior residents are selected by willingness and availability to be preceptors. For the observed history, an OSCE simulated patient format with video taping is used. Faculty evaluates students; students evaluate themselves by reviewing the videotape using a preprinted rater form. Faculty and students meet immediately after student view themselves to share observations with emphasis promoting student's insight regarding performance. For the physical exam, resident preceptors are observed by faculty before they evaluate students. The physical exam is broken into components. The preceptors use a checklist printed on an index card to document observations and remediation of students. Different components are evaluated during various parts of the clerkship. Each component takes 10-15 minutes to evaluate. About 40 students per 8wk block are evaluated.

Results: The students perform the physical exam components under direct observation until all elements are correctly demonstrated. The interaction between the student and patient are evaluated. Informal verbal feedback by students is uniformly positive.

Conclusion: By breaking down the physical exam into components and by recruiting multiple faculty and senior residents, the observed physical exam is feasible. The focus is on immediate remediation of skills and student's insight into patient/parent interactions.