Internal medicine intern performance on the gastrointestinal physical exam

Julia R. Gips; Ariella Apfel Stein; Joyce Luckin; Brian T. Garibaldi

doi:10.1515/dx-2023-0051

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Internal medicine intern performance on the gastrointestinal physical exam

Julia R. Gips , Ariella Apfel Stein , Joyce Luckin und Brian T. Garibaldi

Veröffentlicht/Copyright: 21. Juli 2023

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Aus der Zeitschrift Diagnosis Band 10 Heft 4

Abstract

Objectives

The gastrointestinal (GI) physical exam provides critical information about underlying disease states. However, since assessment of physical examination skills is rarely conducted as part of internal medicine residency training, little is known about resident performance on the GI physical exam.

Methods

During a clinical skills assessment that took place between November 2019 and February 2020, internal medicine interns examined the same patient with chronic liver disease while being observed by faculty preceptors. We compared the exam maneuvers performed with those expected by the faculty evaluators. We noted which maneuvers were performed incorrectly, whether physical exam technique correlated with identification of physical exam findings, and if performance on the physical exam was associated with building an appropriate differential diagnosis. This four-hour assessment was required for internal medicine interns within two different residency programs in the Baltimore area.

Results

More than half of the 29 participating interns (n=17, 58.6 %) received a “needs improvement” score on their physical exam technique. Technique was highly correlated with identifying the correct physical signs (r=0.88, p<0.0001). The most commonly excluded maneuvers were assessing for splenomegaly and hepatomegaly. The most commonly missed findings were splenomegaly and hepatomegaly. Most interns included chronic liver disease as part of their differential diagnosis even if they received “needs improvement” scores on physical exam technique or identifying physical signs.

Conclusions

Internal medicine interns would benefit from learning an organized approach to the gastrointestinal exam. This would likely lead to increased identification of important gastrointestinal findings.

Keywords: bedside diagnosis; gastrointestinal exam; physical exam assessment; physical exam teaching; standardized evaluations in residency

Corresponding author: Julia R. Gips, MD, Department of Medicine, Johns Hopkins Hospital, 1800 Orleans Street Baltimore, MD 21287, Baltimore, USA, Phone: (856) 577 9013, E-mail: jgips1@jhmi.edu

Prior presentations: Abstract presented at the Institute for Excellence in Education Conference at Johns Hopkins School of Medicine March 2022.

Funding source: Johns Hopkins Institute for Excellence in Education Berkheimer Faculty Scholars Award

Funding source: American Board of Medical Specialties Visiting Scholar Program (with support from the Gordon and Betty Moore Foundation)

Funding source: New York Academy of Medicine Jeremiah A. Barondess Fellowship in the Clinical Transaction (in collaboration with the Accreditation Council for Graduate Medical Education)

Award Identifier / Grant number: 10.13039/100007261

Funding source: American Medical Association Reimagining Residency Initiative

Funding source: Douglas Carroll Scholarship from the Johns Hopkins Center for Innovative Medicine

Acknowledgments

The authors would like to acknowledge the outstanding work of the interns and residents of the Johns Hopkins Osler and Bayview medical residencies and the patients who volunteered their time to teach them.

Research ethics: All data collection and recruitment protocols were reviewed and approved by the Johns Hopkins Medicine Institutional Review Board (Protocol IRB00115500).
Informed consent: Informed consent was obtained from all individuals included in this study.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no competing of interest.
Research funding: This work was funded by the Johns Hopkins Institute for Excellence in Education Berkheimer Faculty Scholars Award, the New York Academy of Medicine Jeremiah A. Barondess Fellowship in the Clinical Transaction (in collaboration with the Accreditation Council for Graduate Medical Education), Funder Id: https://doi.org/10.13039/100007261, the American Board of Medical Specialties Visiting Scholar Program (with support from the Gordon and Betty Moore Foundation), the Douglas Carroll Scholarship from the Johns Hopkins Center for Innovative Medicine, and the American Medical Association Reimagining Residency Initiative. The content does not purport to reflect the views of the American Medical Association or any member of the Accelerating Change in Medical Education Consortium. The funding organizations played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

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Received: 2023-04-26

Accepted: 2023-06-27

Published Online: 2023-07-21

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Schlagwörter für diesen Artikel

bedside diagnosis; gastrointestinal exam; physical exam assessment; physical exam teaching; standardized evaluations in residency