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ObjectivesThere is widespread recognition that physical examination (PE) should be taught in Graduate Medical Education (GME), but little is known regarding how to best teach PE to residents. Deliberate practice fosters expertise in other fields, but its utility in teaching PE is unknown. We systematically reviewed the literature to determine the effectiveness of methods to teach PE in GME, with attention to usage of deliberate practice.Data sourcesWe searched PubMed, ERIC, and EMBASE for English language studies regarding PE education in GME published between January 1951 and December 2012.Study eligibility criteriaSeven eligibility criteria were applied to studies of PE education: (1) English language; (2) subjects in GME; (3) description of study population; (4) description of intervention; (5) assessment of efficacy; (6) inclusion of control group; and (7) report of data analysis.Study appraisal and synthesis methodsWe extracted data regarding study quality, type of PE, study population, curricular features, use of deliberate practice, outcomes and assessment methods. Tabulated summaries of studies were reviewed for narrative synthesis.ResultsFourteen studies met inclusion criteria. The mean Medical Education Research Study Quality Instrument (MERSQI) score was 9.0 out of 18. Most studies (n = 8) included internal medicine residents. Half of the studies used resident interaction with a human examinee as the primary means of teaching PE. Three studies "definitely" and four studies "possibly" used deliberate practice; all but one of these studies demonstrated improved educational outcomes.LimitationsWe used a non-validated deliberate practice assessment. Given the heterogeneity of assessment modalities, we did not perform a meta-analysis.Conclusions and implications of key findingsNo single strategy for teaching PE in GME is clearly superior to another. Following the principles of deliberate practice and interaction with human examinees may be beneficial in teaching PE; controlled studies including these educational features should be performed to investigate these exploratory findings.

BackgroundCompetence in quality improvement (QI) is a priority for medical students. We describe a self-directed QI skills curriculum for medical students in a 1-year longitudinal integrated third-year clerkship: an ideal context to learn and practice QI.MethodsTwo groups of four students identified a quality gap, described existing efforts to address the gap, made quantifying measures, and proposed a QI intervention. The program was assessed with knowledge and attitude surveys and a validated tool for rating trainee QI proposals. Reaction to the curriculum was assessed by survey and focus group.ResultsKnowledge of QI concepts did not improve (mean knowledge score±SD): pre: 5.9±1.5 vs. post: 6.6±1.3, p=0.20. There were significant improvements in attitudes (mean topic attitude score±SD) toward the value of QI (pre: 9.9±1.8 vs. post: 12.6±1.9, p=0.03) and confidence in QI skills (pre: 13.4±2.8 vs. post: 16.1±3.0, p=0.05). Proposals lacked sufficient analysis of interventions and evaluation plans. Reaction was mixed, including appreciation for the experience and frustration with finding appropriate mentorship.ConclusionClinical-year students were able to conduct a self-directed QI project. Lack of improvement in QI knowledge suggests that self-directed learning in this domain may be insufficient without targeted didactics. Higher order skills such as developing measurement plans would benefit from explicit instruction and mentorship. Lessons from this experience will allow educators to better target QI curricula to medical students in the clinical years.

BackgroundMedicare has selected 10 hospital-acquired conditions for which it will not reimburse hospitals unless the condition was documented as "present on admission." This "no pay for errors" rule may have a profound effect on the clinical practice of physicians.ObjectiveTo determine how physicians might change their behavior after learning about the Medicare rule.DesignWe conducted a randomized trial of a brief educational intervention embedded in an online survey, using clinical vignettes to estimate behavioral changes.ParticipantsAt a university-based internal medicine residency program, 168 internal medicine residents were eligible to participate.InterventionResidents were randomized to receive a one-page description of Medicare's "no pay for errors" rule with pre-vignette reminders (intervention group) or no information (control group). Residents responded to five clinical vignettes in which "no pay for errors" conditions might be present on admission.Main measuresPrimary outcome was selection of the single most clinically appropriate option from three clinical practice choices presented for each clinical vignette.Key resultsSurvey administered from December 2008 to March 2009. There were 119 responses (71%). In four of five vignettes, the intervention group was less likely to select the most clinically appropriate response. This was statistically significant in two of the cases. Most residents were aware of the rule but not its impact and specifics. Residents acknowledged responsibility to know Medicare documentation rules but felt poorly trained to do so. Residents educated about the Medicare's "no pay for errors" were less likely to select the most clinically appropriate responses to clinical vignettes. Such choices, if implemented in practice, have the potential for causing patient harm through unnecessary tests, procedures, and other interventions.

Summary: Background: Video review of OSCE (objective structured clinical examination) performance allows students to analyse their performance, identify actions and behaviours for correction or reinforcement, and develop a plan for improvement of clinical skills. Student perceptions of the utility of independent and mentored video review are unknown. Methods: We created a pilot programme of post‐OSCE structured video review. Students were randomised to mentored (M) or independent (I) review. In the mentored group, a faculty member facilitated the process. Both groups completed an assessment rubric and created an action plan. We examined student perceptions of the process, helpful elements of each type of review and perceived impact after a follow‐up OSCE. Results: The mentored group (n = 12) was more comfortable watching themselves than the independent group (n = 11); using a five‐point Likert scale, where 1 indicates 'strongly disagree' and 5 indicates 'strongly agree': 3.5 ± 1.2 (I) versus 4.5 ± 0.2 (M) (p = 0.02). The mentored group more strongly agreed that their clinical skills would improve: 3.6 ± 1.1 (I) versus 4.9 ± 0.2 (M) (p < 0.01). After the follow‐up OSCE, the mentored group (n = 10) tended to feel more strongly that their clinical skills had improved compared with the independent group (n = 9): 3.6 ± 1.3 (I) versus 4.3 ± 0.7 (M) (p = 0.14). Discussion: This pilot study demonstrates the utility of using a structured framework for post‐OSCE video review, both for the assessment of performance and for the development of a behavioural action plan. There are advantages to using a mentor‐guided model, but further study is needed to determine whether actual OSCE performances improve as a consequence. Video review of OSCE performance allows students to analyse their performance [ABSTRACT FROM AUTHOR]

Medical educators are expected to teach quality improvement (QI) skills alongside traditional clinical skills such as physical examination and bedside manner. Educational resources for intensive training in QI have proliferated. However, many physicians lack the time or resources to undergo this training, and may struggle with teaching these skills to their learners. In response, we offer twelve tips to help physicians teach basic QI concepts in the clinical environment. By following these tips physicians will be able to engage their learners interest in QI and provide experiential learning that makes a lasting impact. [ABSTRACT FROM AUTHOR]