Assessing Abdominal Examination Skills in a Surgery Clerkship Standardized Patient Encounter for Curriculum Improvement

Hannah Marshall; Laura A Weingartner; Taylen Henry; Jensen Smith; Tiffany Wright; Carrie A Bohnert; M Ann Shaw; Dylan T Adamson

doi:10.1177/23821205241272382

Assessing Abdominal Examination Skills in a Surgery Clerkship Standardized Patient Encounter for Curriculum Improvement

J Med Educ Curric Dev. 2024 Aug 7:11:23821205241272382. doi: 10.1177/23821205241272382. eCollection 2024 Jan-Dec.

Authors

Hannah Marshall¹, Laura A Weingartner¹, Taylen Henry¹, Jensen Smith¹, Tiffany Wright², Carrie A Bohnert¹, M Ann Shaw¹, Dylan T Adamson²

Affiliations

¹ Undergraduate Medical Education, University of Louisville School of Medicine, Louisville, KY, USA.
² Department of Surgery, University of Louisville School of Medicine, Louisville, KY, USA.

Abstract

Introduction: Standardized patient (SP) encounters allow medical students to practice physical examination skills and clinical reasoning. SP cases are used for learning and assessment, but recorded encounters can also be valuable curriculum evaluation tools. We aimed to review SP encounters to improve abdominal examination skills and the broader physical examination curriculum.

Methods: We reviewed recorded SP encounters of third-year medical students on surgery clerkship rotation. Students examined a cisgender woman presenting with acute right lower abdominal pain. We observed abdominal examinations to determine which maneuvers were attempted and completed correctly. We then used these outcomes to develop targeted clerkship training for the subsequent student cohort. Our intervention targeted abdominal examination gaps by explaining how to integrate abdominal examination findings with a focused history for surgical patients. We evaluated the intervention's impact on abdominal examination skills with third-year medical students in comparison (2021-2022, n = 119) and intervention (2022-2023, n = 132) groups.

Results: In both the comparison and intervention groups, nearly all students attempted at least 1 general examination maneuver like auscultation, palpation, percussion, or rebound tenderness. Only 40% of students in the comparison group attempted an advanced maneuver like the Rovsing, Psoas, or Obturator sign. After the intervention, 75% of students in the intervention group attempted an advanced maneuver (χ²(1, 251) = 31.0, p < .001). Cohorts did not gain skills over time through the clerkship. Rebound tenderness was frequently assessed incorrectly by students in both groups, with many avoiding the right lower quadrant entirely.

Conclusions: This project highlights how medical students struggle to utilize abdominal examination maneuvers and integrate findings. The results also showed that students did not consistently learn advanced examination skills either before or during clerkship rotation, which may be commonly assumed by clinical faculty. Finally, this work demonstrates how SP encounters can be used to evaluate and improve surgical education curriculum.

Keywords: assessment; clinical reasoning; clinical skills; medical student; physical examination; simulation.