• Brian Thomas Garibaldi, Timothy Niessen, Allan Charles Gelber, Bennett Clark, Yizhen Lee, Jose Alejandro Madrazo, Reza Sedighi Manesh, Ariella Apfel, Brandyn D Lau, Gigi Liu, Jenna VanLiere Canzoniero, C John Sperati, Hsin-Chieh Yeh, Daniel J Brotman, Thomas A Traill, Danelle Cayea, Samuel C Durso, Rosalyn W Stewart, Mary C Corretti, Edward K Kasper, and Sanjay V Desai.
• Division of Pulmonary and Critical Care, Johns Hopkins University School of Medicine, 1830 East Monument Street, Baltimore, MD, 21287, USA. bgariba1@jhmi.edu.
• BMC Med Educ. 2017 Oct 6; 17 (1): 182.

BackgroundPhysicians spend less time at the bedside in the modern hospital setting which has contributed to a decline in physical diagnosis, and in particular, cardiopulmonary examination skills. This trend may be a source of diagnostic error and threatens to erode the patient-physician relationship. We created a new bedside cardiopulmonary physical diagnosis curriculum and assessed its effects on post-graduate year-1 (PGY-1; interns) attitudes, confidence and skill.MethodsOne hundred five internal medicine interns in a large U.S. internal medicine residency program participated in the Advancing Bedside Cardiopulmonary Examination Skills (ACE) curriculum while rotating on a general medicine inpatient service between 2015 and 2017. Teaching sessions included exam demonstrations using healthy volunteers and real patients, imaging didactics, computer learning/high-fidelity simulation, and bedside teaching with experienced clinicians. Primary outcomes were attitudes, confidence and skill in the cardiopulmonary physical exam as determined by a self-assessment survey, and a validated online cardiovascular examination (CE).ResultsInterns who participated in ACE (ACE interns) by mid-year more strongly agreed they had received adequate training in the cardiopulmonary exam compared with non-ACE interns. ACE interns were more confident than non-ACE interns in performing a cardiac exam, assessing the jugular venous pressure, distinguishing 'a' from 'v' waves, and classifying systolic murmurs as crescendo-decrescendo or holosystolic. Only ACE interns had a significant improvement in score on the mid-year CE.ConclusionsA comprehensive bedside cardiopulmonary physical diagnosis curriculum improved trainee attitudes, confidence and skill in the cardiopulmonary examination. These results provide an opportunity to re-examine the way physical examination is taught and assessed in residency training programs.

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