Common difficulties medical students have with the neurological physical exam are identified by direct observation

Objective: To identify common errors in the neurological physical exam made by third year neurology clerkship students using direct observation. Background: Previous studies have described the importance of physical examination in obtaining an accurate diagnosis and improving confidence in a suspected diagnosis based on medical history. If students are unable to perform examination techniques correctly, their ability to utilize the physical exam as a diagnostic tool is diminished. Direct observation of students performing the neurological exam has been demonstrated to be a feasible exercise during the neurological clerkship. However, we have not found any published data on which aspects of the exam are most difficult for students to perform correctly. Design/Methods: During three academic years (2014–15 to 2016–17), 3 rd year neurology clerkship students at The Ohio State University College of Medicine were directly observed conducting a screening neurological exam by faculty members from the department of neurology. All students examined live patients who were typically admitted to an inpatient service. The observations were recorded on a third party iPad app by neurology faculty who were able to make narrative comments on student performance. These comments were used to identify areas in which the physical exam could be improved. Results: Observations were recorded for 505 students. Portions of the neurological exam most frequently identified as needing improvement were deep tendon reflexes and the motor/strength exam. Cranial nerve and coordination testing were aspects of the exam with the least comments suggesting need for improvement. Conclusions: Our findings from faculty observation of student clinical skills has identified portions of the neurological exam students most commonly struggle to perform correctly. By focusing efforts on teaching these aspects of the neurological exam and providing students with feedback through direct observation, neurology educators can improve student physical exam skills in a focused and efficient manner. Disclosure: Dr. Coleman has nothing to disclose. Dr. Hoyle has nothing to disclose. Dr. Cios has nothing to disclose. Dr Quick has nothing to disclose.