Avaliação dos residentes de ortopedia e traumatologia utilizando o mini-cex com foco no exame físico
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2017-02-22
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Universidade Federal de Goiás
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Introduction: The ability to perform physical exam is essential in clinical practice in any medicine field. Observation, teaching and performing the physical examination is often poorly emphasized during the residency of Orthopedics and Traumatology. In order to promote staff’s observation American Boar of Internal Medicine proposed the Mini-Clinical Evaluation Exercise (mini-CEX). Our goal is assess Orthopaedic and Traumatology’s resident, using min-CEx, focusing on physical exam performance. Methods: It is study quantitative, transversal, descriptive and exploratory. The data were obtained using questionnaire and mini-Cex from March to June 2016, in four meetings. 21 residents were evaluated, totalizing 84 assessments. The evolution of the residents (R1, R2 and R3) evaluated by the Mini Cex was performed based on the Friedman test, followed by the analysis of multiple PosHoc comparisons. The comparative analysis of the assessments according to the resident's year at each meeting was performed using the Kruskal-Wallis test followed by the analysis of multiple PosHoc comparisons. Results: Through the Beran questionnaire, 81% of residents reported never / rarely or occasionally having been observed and criticized when performing the clinical examination. It was found that the residents presented a satisfactory result in the assessment of their clinical competences, in a scale ranging from 1 to 9. The scores obtained in the physical examination in mean ± standard deviation were 4,00 ± 1.89 for R1 (first year resident), 5.00 ± 1.82 for R2 (second year resident) and 5.09 ± 1.84 for R3 (third year resident). In the clinical history the scores were; 3.96 ± 2.08 for R1, 5.29 ± 1.63 for R2 and 5.56 ± 1.78 for R3. In the clinical reasoning we had 4.82 ± 1.63 for the R1, 6,13 ± 1,48 for the R2 and 6,31 ± 1,47 for the R3. It was observed a high satisfaction of the evaluated residents (R1 - 8.79 ± 0.63, R2 - 8.71 ± 0.46 and R3 - 8.78 ± 0.49), staffs were also satisfied (R1 - 8,15 ± 0,99; R2 - 8,21 ± 0,98; R3 - 8,38 ± 0,75). Despite satisfactory performance, there were some gaps in physical examination learning. In 75% of the evaluations performed, the residents had trouble in special orthopedic tests, 65.5% were not able to identify specific signs of physical examination that could assist in the diagnosis, and 91.7% did not follow a logical and effective order. Conclusion: The evaluation of the resident of Orthopedics and Traumatology through the mini-CEX was satisfactory, however learning gaps were identified especially in the physical examination. Educational intervention is suggested
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SILVA, B. A. M. Avaliação dos residentes de ortopedia e traumatologia utilizando o mini-cex com foco no exame físico. 2017. 75 f. Dissertação (Mestrado em Ensino na Saúde) - Universidade Federal de Goiás, Goiânia, 2017.