225298 A single-blinded, direct observational study of PGY-1 and PGY-2 residents in evaluating their history-taking and physical examination skills

Tuesday, November 9, 2010 : 4:30 PM - 4:45 PM

Sandeep Sharma, MD, DrPH(c) , Institute for Health Sciences and Practice/ Dept. of Health Policy and Management, New York Medical College, Valhalla, NY
Background: Medical interns and PGY-2 residents are often the first contact for newly admitted patients in a teaching hospital.

Methods: An independent medical observer uses a yes/no checklist with 61 variables, in a single-blinded observational study. Frequency tables were generated and results were based on descriptive statistics. 25 newly admitted patient encounters using 15 different medical interns and 2nd year residents.

Results: The results were worse than anticipated. In 5 of the 7 categories aimed at chart review for accuracy, it was found that the majority of interns and 2nd year residents lied about findings they had recorded in the patient's chart, when in fact, during their patient encounter, the questions were never asked nor the procedures done. In 64% of the 25 encounters, the time spent on history-taking was less than 7 minutes. In 68% of the 25 patient encounters, the time spent for the physical examination was less than 5 minutes. Regarding history-taking, in 72% of the encounters, patients were not asked about family medical history. No patients were asked about level of salt intake, despite encountering patients with history of hypertension. No patients were asked about recent weight loss or weight gain. None of the interns or PGY-2 residents took their own measurements of the patient's blood pressure. There were no examinations of the fundus, no examinations for accommodation, 76% of encounters were not examined for pupillary light reflex. In 96% of the encounters, there were no eye movement tests done. In 92% of the encounters, there were no pulses measured using a watch. The carotids were not examined in any of the patients. The thyroid was not examined in any of the patients. Hearing was not tested in any of the patients. In only 16% of the encounters, the intern or 2nd year resident looked in the patient's throat. In 88% of the encounters, reflexes were not tested. Muscle strength was not tested in 80% of the 25 patients. Sensory was not tested in 96% of the encounters. Gait was not tested in 92% of the encounters. Pedal edema was not checked in 68% of the patient encounters.

Conclusions: The single-blinded nature of this study exposed the poor overall performance of our interns/residents in the quality of their history-taking and physical examination skills on newly admitted patients. Surprisingly, the percentage of interns and residents lying when recording information in the patient's chart was high.

Learning Areas:
Public health or related public policy

Learning Objectives:
Objectives: 1) Evaluate the completeness of history-taking and physical examination skills of interns and 2nd year residents on new admissions to the medical floors. 2) Compare data gathered from the patient encounter to the patientís chart for evidence of accuracy. 3) Identify the time quantity and quality of initial encounters that patients face everyday upon admission to the medical floors.

Keywords: Medical Care, Education

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: Having affiliations with 2 medical teaching institutions and spending time in the teaching hospitals, I thought this was an important obvervational study to conduct as an evaluation of 1 of the teaching hospital's medical residency program.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.