Performance of the vascular physical examination by residents and medical students.

Abstract

This study uses an objective structured clinical examination to evaluate the performance and interpretation of the vascular physical examination by interns and medical students. A patient with lower extremity arterial occlusive disease findings was examined by 20 third-year students (M3), 23 physicians entering surgical internship (PGY1), and 7 individuals completing internship (PGY2). The test consisted of two sections: part A evaluated the individuals' ability to perform a pulse examination (data gathering); part B evaluated the interpretation of the physical examination findings (data interpretation). National Board of Medical Examiners Part II examination results were obtained for 84% of participants. All groups performed poorly, with overall correct percent scores being 43% (M3), 39% (PGY1), and 62% (PGY2). PGY2s performed significantly better than M3s or PGY1s (p = 0.0002). No statistical difference was noted between M3 and PGY1 scores. Overall, data gathering skills were significantly better than data interpretation skills (51% vs 37%, p = 0.0001). National Board of Medical Examiners Part II scores did not vary substantially among groups. Interns and medical students demonstrated considerable inaccuracy in both data gathering and data interpretation. A modest improvement was observed in individuals tested at the end of the internship year. This study suggests that increased attention should be directed toward instructing surgical residents and students how to perform an accurate peripheral vascular physical examination and how to interpret its significance.