COMSEP 2008 Atlanta Meeting
Development of a Physical Exam Resident as Teacher Curriculum
Kimberly Gifford and Leslie Fall
Dartmouth Medical School
Objective: In order to design a targeted pediatric physical exam (PE) Resident as Teacher curriculum, we validated residents’ perception of their physical examination and teaching skills against students’ perception of their learning during the pediatric clerkship.
Methods: Focus groups were held with medical students and residents to define the current teaching methods and relative strengths for specific PE components in the existing clerkship curriculum. Third year students at the end of the clerkship (n=17) and pediatric residents (n=10) were then formally surveyed to validate the themes generated by the focus groups.
Results: Of the 8 PE components surveyed, student-reported satisfaction with teaching on a 5 point Likert scale (1= very dissatisfied, 5= very satisfied) was greatest for the ear (4.3; SD=0.6) and lowest for the eye (3.1; SD=1.0) exam. Only 53% of students reported receiving feedback about their eye exam vs. 76% for their ear exam. For both the gait and knee exam, only 35% of students reported having the exam modeled for them vs. 71% for the ear exam. There was a statistically significant improvement in student-reported comfort level with the ear exam (+0.8, SD=0.6) during the clerkship, but not for eye, gait or knee. Resident reported comfort level with teaching was lowest for the eye (1.6, SD=0.5), knee (1.8, SD=0.6) and gait (1.9, SD=0.3) exams on a 3 point Likert scale (1=not comfortable, 3=very comfortable). Resident comfort performing PE components was correlated with comfort teaching them (r=0.87).
Discussion: Students and residents reported similar trends in teaching strength for the 8 specific PE components surveyed, and residents were most comfortable teaching skills that they were comfortable performing. Thus our curriculum focuses on targeting the residents’ weakest PE skills combined with instruction in effective teaching methods for modeling and feedback. Our primary evaluation outcome will be the impact these interventions have on improving medical student comfort with performing these skills at the end of the clerkship.