Learning abnormal physical examination signs: an introductory course

Albert Sabirov, MD, PhD; Melodie Chludzinski, DO, MHSA; Emin Eminof, BS; Alexis Eddy, BS; John Gallagher, DO; and Ichabod Jung, MD, FACS
Notes and Affiliations
Notes and Affiliations

Received: August 10, 2022

Accepted: November 2, 2022

Published: March 31, 2023

  • Albert Sabirov, MD, PhD, 

    Department of Basic Science, Lake Erie College of Osteopathic Medicine, Erie, PA, USA

  • Melodie Chludzinski, DO, MHSA, 

    Lake Erie College of Osteopathic Medicine, Erie, PA, USA

  • Emin Eminof, BS, 

    Lake Erie College of Osteopathic Medicine, Erie, PA, USA

  • Alexis Eddy, BS, 

    Lake Erie College of Osteopathic Medicine, Erie, PA, USA

  • John Gallagher, DO, 

    Department of Internal Medicine, Millcreek Community Hospital, Erie, PA, USA

  • Ichabod Jung, MD, FACS, 

    Urology Residency Research Director, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, Buffalo, NY, USA

J Osteopath Med; 123(6): 295-299

Context: The acquisition of clinical skills is an essential part of the osteopathic medical school curriculum. Preclinical medical students, especially at osteopathic medical schools, have limited exposure to abnormal physical examination (PE) findings that are not typically seen in a student’s peers or in a standardized patient (SP). The early exposure of first-year medical students (MS1s) to normal and abnormal findings in the simulation settings better equips them to identify abnormalities when they encounter them in a clinical setting.

Objectives: The aim of this project was to develop and implement the introductory course on learning abnormal PE signs and pathophysiology of abnormal clinical findings to address the educational needs of MS1s.

Methods: The didactic part of the course consisted of PowerPoint presentations and lecture on the topics related to the simulation. The practical skill session was 60 min, during which time students first practiced PE signs and then were assessed on their ability to accurately identify abnormal PE signs on a high-fidelity (HF) mannequin. Faculty instructors guided students through clinical cases and challenged them with probing questions in clinically relevant content. Before- and after-simulation evaluations were created to assess students’ skills and confidence. Student satisfaction levels after the training course were also assessed.

Results: This study demonstrated significant improvements in five PE skills (p<0.0001) after the introductory course of abnormal PE clinical signs. The average score for five clinical skills increased from 63.1 to 88.74% (before to after simulation). The confidence of students in performing clinical skills and their understanding of the pathophysiology of abnormal clinical findings also increased significantly (p<0.0001) after simulation activity and educational instruction. The average confidence score increased from 3.3 to 4.5% (before to after simulation) on a 5-point Likert scale. Survey results demonstrated high satisfaction with the course among learners with mean satisfaction score 4.7 ± 0.4 on 5-point Likert scale. The introductory course was well received by MS1s and they left positive feedback.

Conclusions: This introductory course offered MS1s with novice PE skills the ability to learn a variety of abnormal PE signs, including heart murmurs and rhythms, lung sounds, measurement of blood pressure (BP), and palpation of the femoral pulse. This course also allowed abnormal PE findings to be taught in a time-efficient and faculty-resource–efficient manner.

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