P0645 - Going Back to the Basics at the Bedside: Instituting Physical Exam Teaching Rounds to Improve Skills and Teaching in Residency

Background:
Resident competence in physical exam skills is lacking. Despite the advantages technology has afforded modern medicine, the reliance on laboratory and radiologic data has contributed to a decline in bedside clinical skills.

Multiple articles report that bedside teaching has declined, from once making up about 75% of clinical teaching in the 1960s to only 16% by 1978. Over time, residents have become less familiar with physical signs, causing them to place less importance on this part of patient care.
Physical exam teaching in medical school is variable and few residency programs have formal physical exam teaching curricula. Improving on these skills relies on the senior residents or attending physicians to actively seek out teaching opportunities or work these into daily rounding. The inherent problem, however, is that if senior residents and faculty themselves are lacking confidence in physical exam skills, they are less likely to teach junior residents, leading to an ever-worsening cycle.

Methodology:
We created a program of weekly physical exam rounds for residents led by a resident on our existing medical education elective and an attending skilled in bedside teaching. Patients with key physical exam findings are identified by residents each week and placed on a designated EMR list. The resident is primarily responsible for the pre-planning as well as teaching of bedside rounds. The faculty member functions to help the resident plan his or her teaching, provide expert commentary throughout the session, and provide feedback to the resident after rounds.

Discussion:
Literature supports the need for more directed teaching in physical exam skills in residency – in our experience, though, many well-intentioned physical diagnosis rounds are ultimately unsuccessful due to lack of sustainability. Much of this may stem from the amount of preparatory work required beforehand.

We believe we may have circumvented some of those obstacles in that a rotating resident manages the majority of planning and teaching. This allows the core group of faculty members to remain involved without being over-extended. Our program fosters mentorship by affording faculty the opportunity to not only teach physical exam skills, but also mentor and give feedback to a new bedside teacher. We hope that by incorporating physical exam teaching rounds into our pre-existing medical education elective, our program will remain in place for years to come. We plan to prospectively evaluate resident confidence and physical exam performance in the near future.

Conclusion:
Creating a dedicated curriculum for bedside teaching in physical exam has reintroduced clinical skills that have declined over recent decades. Our programs sustainability will allow residents to experience this teaching in years to come, with the hope that upon graduation, they will have acquired the skills to incorporate bedside teaching into their own clinical practice.