Fourth-year medical students do not perform a focused physical examination during a case-based simulation scenario

Leslie A Bilello,1 Nicole M Dubosh,1 Jason J Lewis,1 Matthew M Hall,1 Jonathan Fisher,2 Edward A Ullman1 1Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA; 2Department of Emergency Medicine, Maricopa Medical Center, Phoenix, AZ, USA Background: The art of physical examination is one of the most valuable diagnostic tools bestowed upon new generations of medical students. Despite traditional educational techniques and significant attention on a national level, both trainees and educators have noticed a decrease in physical examination proficiency. Simulation has been identified as a potential way to improve physical examination techniques within undergraduate medical education. We sought to determine the utility of a cardiac case-based simulation scenario to assess physical examination performance of fourth-year medical students during an emergency medicine (EM) clerkship.Materials and methods: Fourth-year medical students enrolled in a 4-week EM clerkship were prospectively evaluated during a case-based scenario using a simulation mannequin (Laerdal SimMan®). The case involved a patient presenting with chest pain that evolved into cardiac arrest. All simulations were video recorded and two emergency physicians reviewed each video. The reviewers recorded whether or not each student completed the essential components of a focused physical examination.Results: Twenty-seven students participated in the simulation. The percentage of students completing each of the four components of the physical examination was as follows: cardiac auscultation 33.3% (95% CI 18.5–52.3), lung auscultation 29.6% (95% CI 15.7–48.7), pulse and extremity examination 55.6% (95% CI 37.3–72.4), and abdominal examination 3.70% (95% CI 0–19.8). None of the students completed all four of these components.Conclusion: Our study showed that fourth-year medical students did not uniformly perform components of a focused physical examination during a high-acuity chest pain simulation scenario. Although our study showed limited physical examination performance, simulation allows evaluators to observe and provide constructive feedback and may lead to an improvement in these skills. These findings call for improved technology to increase authenticity of simulators and continued faculty development for more creative, meaningful integration of physical examination skills into high-acuity simulation cases. Keywords: emergency medicine, medical student education, undergraduate medical education, physical examination skill