865 Differences In Teaching “General Physical Examination”

P C. Unalan 1, A Uzuner 1, S Cifcili 1, M Akman 1
1 University Of Marmara-Family Medicine Department
In a lot of medical school many single subjects and skills are taught by doctors from a variety of disciplines during different years. Students often receive different messages by observing different physicians about the same skill or procedure. As medicine is a profession that is made of “art” as well as “science”, some individual differences should remain. These individual differences can be accepted if there is reliability between tutors. But students find this confusing. Teaching physical examination is such a subject. Objective: To examine the competency of year four medical students about general physical examination which is taught by family medicine in year 3 clinical skills laboratory, and to determine whether there is agreement between family medicine and internal medicine departments.
Design: An OSCE with a simulated patient is held about by 40, year four undergraduates. OSCE is observed by two physicians (one from family medicine, the other from related discipline) with same check-lists. Students who are on their internal medicine rotation had not been included in the assessment. 16 students had been evaluated about respiratory system, 14 about abdominal, 10 about cardiovascular system examination.
Results: Respiratory system examination was completed successfully by most of the students. Failure was observed during diaphragmatic percussion and auscultation of post axillary area by both of the raters. Kappa 0,84 and 0,60 was found respectively. Liver and spleen percussion were the most successful parts of the abdominal examination and inter-rater agreement was strongly observed (Kappa 0,84 for both). Students mostly failed in cardiovascular system examination and what is more inter-rater agreement was very weak or absent in this part.
Resolving this agreement between tutors from different disciplines may be possible by defining the learning objectives and structuring check-lists together. What is more relying on evidence based literature.