Background
Physical examination (PE) is an essential component of high-quality medical care that can aid in diagnosis, guide workup, and impact management decisions. Incomplete or deficient PE is a common source of diagnostic error and contributes to adverse patient outcomes. PE is one of many skills that should be developed and cultivated during medical training, but direct observation of, and feedback regarding, PE is limited. The coronavirus disease 2019 (COVID-19) pandemic led to a marked increase in telemedicine visits and a decline in in-person appointments, posing new challenges to performing the PE. Furthermore, while PE skills are associated with competency in other clinical domains during in-person encounters, little is known about PE skills during telemedicine encounters.

Methods
Forty-five internal medicine interns (24 females and 21 males) from two academic health centers participated in a clinical skills assessment via an online platform where they were evaluated by volunteer patients and faculty preceptors. Preceptors rated resident performance in seven domains: 1) physical examination technique; 2) identification of physical signs; 3) clinical communication; 4) differential diagnosis; 5) clinical judgment; 6) management of patient concerns; and 7) maintenance of patient welfare. The Spearman correlation coefficient was used to evaluate relationships between performance in these domains. Resident self-ratings for each domain were also obtained and compared to preceptor scores.

Results
PE technique was significantly correlated with accurate identification of physical signs (r = 0.42, P = 0.004), clinical communication (r = 0.31, P = 0.036), clinical judgment (r = 0. 60, P < 0.0001), and managing patient concerns (r = 0.41, P = 0.005). Residents rated their performance more highly than did preceptors on the domains of clinical communication, clinical judgment, and managing patient concerns. Residents highly rated the feedback they received during the experience.

Conclusion
While the telemedicine PE differs from the in-person PE, our findings highlight that it remains an essential clinical skill that is associated with performance in multiple other clinical domains. Given the rise in telehealth visits during the COVID-19 pandemic and resident overestimation of their skills, there is an increased need for dedicated telemedicine PE teaching.

Assessment of graduate medical trainee clinical skills during telemedicine encounters

Medical Education Innovation | Internal Medicine

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