背景:标准化的患者(SP)接触允许医学生练习体格检查技能和临床推理。SP案例用于学习和评估,但是记录的相遇也可以是有价值的课程评估工具。我们旨在回顾SP遇到的情况,以提高腹部检查技能和更广泛的体格检查课程。
方法:我们回顾了三年级医学生关于外科医师轮岗的SP遭遇记录。学生检查了一名患有急性右下腹痛的顺式女性。我们观察腹部检查以确定尝试并正确完成了哪些动作。然后,我们利用这些结果为随后的学生队列开发有针对性的文员培训。我们的干预措施通过解释如何将腹部检查结果与手术患者的重点病史相结合来针对腹部检查差距。我们评估了干预措施对三年级医学生腹部检查技能的影响(2021-2022,n=119)和干预(2022-2023,n=132)组。
结果:在比较组和干预组中,几乎所有的学生都尝试了至少1次像听诊这样的一般考试操作,触诊,打击乐器,或反弹压痛。对照组中只有40%的学生尝试了像Rovsing这样的高级操作,腰肌,或闭孔标志。干预之后,干预组75%的学生尝试了高级操作(χ2(1,251)=31.0,p<.001)。随着时间的流逝,队列并没有获得技能。两组学生经常错误地评估回弹压痛,许多人完全避开右下象限。
结论:这个项目突出了医学生如何努力利用腹部检查手段和整合发现。结果还表明,学生在担任职位轮换之前或期间都没有始终如一地学习高级考试技能,这可能是临床教师通常假设的。最后,这项工作展示了如何使用SP遇到来评估和改进外科教育课程。
BACKGROUND: Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum.
METHODS: We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention\'s impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups.
RESULTS: In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ2(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely.
CONCLUSIONS: This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.