Background: The purpose of this research was to use direct observation of the physical examination to elucidate the role physical examination technique plays in diagnostic accuracy. Physical examination is important for quality clinical care and requires multiple interrelated skills. The relationship of physical examination technique to related skills is poorly understood. Current methods of teaching and assessing physical examination skills provide few opportunities to evaluate physical examination technique and accuracy.
Methods: The authors developed a clinical examination assessment using volunteer patients and direct observation. Trained faculty preceptors rated resident performance in 7 domains: 1) physical examination technique, 2) identification of physical signs, 3) clinical communication, 4) differential diagnosis, 5) clinical judgment, 6) managing patient concerns, and 7) maintaining patient welfare. The Pearson correlation coefficient was used to determine relationships between performance in each of these domains. Data on residents' self-assessed competency in the physical examination and perceptions of feedback received during the assessment were collected.
Results: From December 2018 to February 2020, 113 interns from 2 internal medicine residency programs participated in the assessment. Physical examination technique was significantly correlated with accurate identification of physical signs, differential diagnosis and clinical judgment. Time spent in graduate medical education was negatively correlated with performance. Interns more highly rated the feedback received from this assessment than traditional clinical skills feedback.
Conclusions: Our findings emphasize the necessity of multi-dimensional physical examination assessment. Observed deterioration of physical examination skill during internship may reflect contemporary practice patterns, which deprioritize the physical examination. Future research on physical examination education should focus on the interface between physical examination technique and related clinical skills.
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http://dx.doi.org/10.1016/j.amjmed.2021.11.021 | DOI Listing |
Proc Natl Acad Sci U S A
February 2025
College of Agronomy, Hunan Agricultural University, Changsha 410128, China.
Seed color is a critical quality trait in numerous plant species. In oilseed crops, including rapeseed and mustard, yellow seeds are distinguished by their significantly higher oil content and faster germination rates compared to black or brown counterparts. Despite the agronomic significance of the yellow seeds being a prime breeding target, the mechanisms underlying elevated oil content remain obscure.
View Article and Find Full Text PDFPLoS One
January 2025
Institute of Physiotherapy, FH Joanneum University of Applied Sciences, Graz, Austria.
The impact of cognitive decline in older adults can be evaluated with dual-task gait (DTG) testing in which a cognitive task is performed during walking, leading to increased costs of gait. Previous research demonstrated that higher DTG costs correlate with increasing cognitive deficits and with age. The present study was conducted to explore whether the relationship between the DTG costs and cognitive abilities in older individuals is influenced by sex differences.
View Article and Find Full Text PDFPLoS One
January 2025
Cardiology Department, Vétérinaire Clinic Boulogne Roland Garros, Boulogne Billancourt, France.
Introduction: Aortic stenosis (AS) and pulmonic stenosis (PS) are two of the most common canine congenital heart diseases (CHD), with a high relative risk for Newfoundland dogs to develop inherited subvalvular AS. For this reason, a cardiovascular screening program has been set up by the French Newfoundland kennel club in order to manage mattings and reduce AS prevalence.
Materials And Methods: The records of untreated and non-anesthetized adult Newfoundland dogs screened between 2010 and 2023 were retrospectively reviewed.
PLoS One
January 2025
Department of Emergency, Shenzhen Second People's Hospital, Shenzhen, Guangdong, China.
Objectives: The pulse pressure (PP) is an important factor influencing the outcomes of diabetes. However, the relationship between the PP and prediabetes has been rarely studied and how this association might be impacted by hypertension is not clear.
Methods: In this study, we retrospectively included 184,252 adults from 32 regions in China, spanning from 2010 to 2016.
PLoS One
January 2025
Laboratory of Veterinary Biochemistry, School of Veterinary Medicine, Rakuno Gakuen University, Ebetsu, Hokkaido, Japan.
Hand-rearing of marine mammals is an essential technique for the husbandry of orphans in captivity or the wild, especially endangered cetacean species. The purpose of the present study was to establish a method for successful hand-rearing and evaluate the nutritional state of neonatal finless porpoises. Two neonate finless porpoises maternally neglected at 5 days of age (Day 5) (neonate A, animal A) and Day 4 (neonate B, animal B) were hand reared.
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