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PubMed1994

Anterior rectocele: assessment with radiographic defecography, dynamic magnetic resonance imaging, and physical examination.

PURPOSE: The aim of this study was to devise a measuring method for an anterior rectocele on standardized defecographies and magnetic resonance images (MRI) to quantify anterior rectocele and to test whether this could substantiate clinical decision making for operative treatment for anterior rectocele. METHODS: Quantitative analysis by the measuring method as proposed was compared with qualitative scores on defecographies and MRI from the same patients. Thirty-eight patients with symptoms compatible with an anterior rectocele were subjected to physical examination in the left decubitis position and supine position and to defecography. Findings on defecography were compared with findings on physical examination. Thirteen patients were examined before and after surgical correction of the anterior rectocele for a total of 51 qualitative and quantitative examinations. The group of operated patients was analyzed for treatment results. Nineteen controls were included. RESULTS: Sixty-six radiographs of 33 defecographies were qualified in three grading classes and quantified with the proposed method by two observers. The mean measured value of the anterior rectocele in the three subjective grading classes is significantly different (P < 0.001). Anterior rectoceles qualified as severe had a measured value of 20 mm or more in 96 percent of the radiographs. Lower gradings were never > 20 mm. On MRI severe anterior rectoceles were not scored and measured values did not correlate with qualitative scores. When findings on physical examination were compared with defecographic measurement, the coefficient of correlation (r) between the radiologic assessment and clinical examination in the left decubitis position is r = 0.87, for the examination in the supine position, r = 0.77. All 15 cases scored as severe anterior rectocele in the left decubitis position had a measured anterior rectocele of > or = 20 mm. In the 13 cases that received surgery, there was a significant reduction of the anterior rectocele (P < 0.001) and clinical improvement. Patients with small or moderate anterior rectocele on physical examination with a size > or = 20 mm on defecography were cured by surgical correction. None of the controls had an anterior rectocele on physical examination or an anterior rectocele > or = 20 mm on defecography. CONCLUSIONS: An anterior rectocele with a size of 20 mm or more corresponds with a qualitative score of "severe" on radiographic defecography. Physical examination for anterior rectocele in the left decubitis position corresponds best with quantitative radiographic assessment and anterior rectocele with a size > or = 20 mm on defecography is pathologic. Patients with complaints compatible with anterior rectocele can be assessed in objective and quantitative terms by radiography and can be successfully surgically treated, even if at physical examination the anterior rectocele is not classified as large, provided that dynamic defecography shows an anterior rectocele of > or = 20 mm. The potential of dynamic MRI with regard to anterior rectoceles presently seems absent.

Adult↗

PubMed1995

Accuracy of the initial history and physical examination to establish the etiology of erectile dysfunction.

OBJECTIVES: Because of its implications for possible therapy, the ability to establish a diagnosis of erectile dysfunction (ED) solely on the basis of history and physical examination has been a matter of controversy. The determination of the etiology of ED based on history and physical examination is evaluated in this present study. METHODS: Consecutive patients presenting for evaluation of ED were evaluated by careful history, physical examination, psychologic evaluation, and RigiScan monitoring. They were then stratified into either organic or psychogenic groups based on each of these modalities. These diagnoses were then compared to a final diagnosis obtained through additional testing. RESULTS: History and physical examination had a 95% sensitivity but only a 50% specificity in diagnosing organic ED. The accuracy rates of history and physical examination in diagnosing ED were 80% and 60%, respectively. CONCLUSIONS: A multifaceted comprehensive approach is required to evaluate fully and to diagnose ED.

Adult↗

PubMedDate not supplied

Multilevel surgery in spastic diplegia: evaluation by physical examination and gait analysis in 25 children.

Gait improvement surgery was performed on 25 ambulatory children with the diplegic type of cerebral palsy. Multiple soft tissue and bony procedures were performed (mean 8.2 procedures) according to criteria defined on the basis of physical examination and gait analysis. Relevant physical examination findings and kinematic and kinetic data in the sagittal plane were evaluated before surgery and at least 3 years after surgery. Physical examination showed a reduction in the ankle plantar-flexor power and in the range of hip flexion and ankle plantarflexion after surgery. Analysis of gait data showed significant improvements in the sagittal plane kinematics and the power generation at the hip and the ankle. At the knee joint there was maintenance of power of the flexor and extensor group of muscles on physical examination, with significant improvements in the kinematics after surgery. The authors conclude that well-selected surgery improves function of the spastic muscle. The importance of assessing clinical, kinematic, and kinetic data together for proper evaluation of gait is stressed.

Adolescent↗

PubMed2002

Lymphomatous superficial lymph nodes: limitations of physical examination for accurate staging and response assessment.

BACKGROUND AND OBJECTIVES: Superficial lymph nodes in lymphoma management are usually evaluated by physical examination. However the accuracy of this assessment has not been thoroughly tested and so it remains debated whether physical examination can meet the international requirements for clinical evaluation and response assessment. DESIGN AND METHODS: Palpatory size estimates of lymph nodes in 97 lymphoma patients were separately compared with ultrasonographic (US) measurements in cervical, supraclavicular, axillary and inguinal regions. Comparisons were made between the products of lymph node cross-sectional diameters, whose changes are critical to assess response. Statistical analysis was carried out by simple linear regression, in which the palpatory estimate was entered as the mean of the measurements separately taken by two different clinicians and the dependent variable was the US measurement. RESULTS: Physical examination tended to underestimate the lymph node size in all regions but appeared to be closely related to US measurements. However, while R2 was very high for cervical and inguinal lymph nodes (0.902 and 0.802, respectively), it was disappointingly low for lymph nodes in supraclavicular and axillary regions (0.529 and 0.368, respectively). INTERPRETATION AND CONCLUSIONS: This indicates that, with the current response criteria, pre- and post-treatment evaluation of cervical and inguinal lymph nodes makes substantial errors in 20-30% of cases when left to physical examination alone. Errors are even more numerous in supraclavicular and axillary regions. Thus, physical evaluation of superficial lymph nodes should be integrated by US or other imaging techniques for accurate fulfilment of the current standardized guidelines for response assessment.

Diagnostic Errors↗

PubMed2004

Disparities in routine physical examinations among in-school adolescents of differing Latino origins.

PURPOSE: To estimate the prevalence of routine physical examination among in-school adolescents of differing national Latino origins and to assess associations with gender, age, immigrant generational status, language spoken at home, parental education, poverty level, family structure, and insurance status. METHODS: Cross-sectional analysis of Wave I of the National Longitudinal Study of Adolescent Health conducted during 1995. Our sample was limited to adolescents in grades 7 through 12 of Mexican (n = 1657), Cuban (n = 490), Puerto Rican (n = 555), and Central/South American or Dominican (C/S American or DR) (n = 427) origins. We used multivariate logistic regression for survey data to conduct the data analyses. RESULTS: Mexican-origin adolescents were less likely to report a routine physical examination in the previous year, compared with other Latino populations [prevalence (95% confidence interval)]: Mexicans, 47.7 % (42.0% -53.6%], Cubans 67.6% (57.4%-76.4%), Puerto Ricans 65.2% (58.4%-71.4%), and C/S American or DR (57.0% [47.3-66.2]). Among Mexican-origin adolescents, having a college-educated parent or insurance was associated with receiving care (adjusted prevalence odds ratio [95% confidence interval]), 2.12 (1.37-3.30) and 1.80 (1.31-2.47), respectively. For Cuban-origin adolescents, first-generation immigrants were less likely to receive care (0.31 [0.14-0.70]), and those living in a single-parent home were more likely to receive care (2.83 [1.52-5.25]). Having a routine physical examination among adolescents of C/S American or DR origins was associated with incomes above the poverty level (2.29 [1.10-4.77] and insurance (2.33 [1.10-4.91]). CONCLUSIONS: Reflecting the heterogeneity of Latino adolescents, the prevalence of routine physical examination and factors associated with it varied by national origin subgroup. These differences should be considered when developing strategies to better address the health needs of Latino youth.

Adolescent↗

PubMedDate not supplied

A musculoskeletal approach to the preparticipation physical examination. Preventing injury and improving performance.

Preparticipation physical examinations provide information concerning an athlete's ability to participate safely in sports. By collecting information specific to the musculoskeletal system in addition to that from a general medical examination, information can be gained that may improve performance and help prevent certain injuries. Two thousand one hundred seven athletes from a variety of sports from the junior high to the college level were examined using specific tests for flexibility, strength, and endurance. Females were significantly more flexible than were males on all flexibility measurements, and males were significantly stronger than were females on all strength measurements. Upper-body athletes were tighter in dominant side internal rotation and significantly looser in dominant side external rotation. Lower-body athletes, especially females, were significantly tighter in the leg muscles. These results indicate that the adaptations of the musculo-skeletal system are sport specific and depend on the body area that is placed under stress.

Adolescent↗

PubMed1990

Cost effective job placement physical examinations. A decision making framework.

1. Job placement physical examinations are performed to match the worker's physical capabilities with the anticipated job assignment. A careful analysis of the work setting and company philosophy should be done prior to structuring a program for job placement examination. These examinations also provide valuable baseline data. 2. Components of the examination should be tailored to the specific work setting and the identified purposes for performing job placement examinations. Job analysis, careful history taking, physical examination, and laboratory and specialized testing are common aspects. 3. Results obtained in the job placement examination program should be handled carefully and ethically to comply with government regulations and legal implications.

Cost-Benefit Analysis↗

PubMed2000

Physical examination plus chest radiography in penetrating periclavicular trauma: the appropriate trigger for angiography.

BACKGROUND: To determine the role of physical examination, chest radiography, and angiography in the management of periclavicular penetrating trauma. METHODS: A retrospective review of the last 100 patients who suffered periclavicular penetrating trauma was performed. Patients with hard signs of vascular injury went either directly to the operating room or first to the angiography suite depending on their hemodynamic stability. All others underwent angiography and subsequent intervention if needed. The results were examined to determine the role of arteriography in the absence of hard signs of vascular injury. RESULTS: Of the 100 patients in the study, there were 81 without hard signs of vascular injury. All underwent angiography, with 11 "occult" injuries discovered. Each of these patients exhibited some physical examination or chest radiographic finding that may have predicted the presence of vascular injury. Using clinical criteria, physical examination was found to have a sensitivity of 82%, a specificity of 91%, a positive predictive value of 60%, and a negative predictive value of 96%. When coupled with the chest radiographic findings, these numbers were 100%, 80%, 44%, and 100%, respectively. Using these criteria would have eliminated the need for angiography in 56 (69%) patients and would not have missed any injuries. CONCLUSIONS: In patients with periclavicular penetrating trauma, a normal physical examination and chest radiographic excludes vascular injury. Proximity alone does not warrant angiography, although the test may be useful for therapeutic interventions or to plan operative approaches. A prospective study is essential to validate these findings.

Adolescent↗

PubMed2001

Reliability of the lumbar flexion, lumbar extension, and passive straight leg raise test in normal populations embedded within a complete physical examination.

STUDY DESIGN: The study measured the reliability of the passive straight leg raise (SLR) test and lumbar range of motion (LROM) tests measured as continuous variables embedded within a comprehensive physical examination. OBJECTIVES: To determine the reliability of the SLR and LROM test scores when they are measured with a Cybex electronic inclinometer (Lumex, Inc., New York, NY) within a physical examination. SUMMARY OF BACKGROUND DATA: Good published empirical reliability exists for the Cybex and for SLR and LROM tests when the measurements are taken in isolation from other physical examination procedures. Reliability of the Cybex for continuous SLR and LROM measurement within a physical examination has not been assessed, however. METHODS: Forty-five participants were seen by one of two physician/physiotherapist teams. Participants were examined by both team members. The first examiner conducted the first tests and retested 1 week later (intrarater reliability). The second examined the participants the day after their first appointment (inter-rater reliability). RESULTS: Only two scores showed substantial reliability (defined as r > or = 0.60). These scores were left (r = 0.81) and right (r = 0.79) SLR intrarater reliability. All other scores fell below the specified cutoff. CONCLUSIONS: SLR and LROM scores used clinically are collected during comprehensive physical examinations. Most scores gathered under these conditions were not reliable. These findings have implications for the use of clinically derived SLR and LROM scores.

Adult↗

PubMed2003

Physical examination in the care of medical inpatients: an observational study.

BACKGROUND: Little is known about the clinical importance of skilled physical examination in the care of patients in hospital. METHODS: Hospital records of a systematic consecutive sample of patients admitted to a general medical inpatient service were reviewed retrospectively to determine whether physical findings by the attending physician led to important changes in clinical management. Patients with pivotal physical findings were defined by an outcomes adjudication panel as those whose diagnosis and treatment in hospital changed substantially as a result of the attending physician's physical examination. Pivotal findings were classed as validated if the resulting treatment change involved the active collaboration of a consulting specialist. Findings were classed as discoverable if subsequent diagnostic testing (other than physical examination) would probably have led to the correct diagnosis. Class 1 findings were those deemed validated but not discoverable. FINDINGS: Among 100 patients, 26 had pivotal physical findings (26%; 95% CI 18-36). 15 of these (58%; 95% CI 37-77) were validated (13 with urgent surgical or other invasive procedures) and 14 were discoverable (54%; 95% CI 33-73). Seven patients had class 1 findings (7%; 95% CI 3-14). INTERPRETATION: Physical examination can have a substantial effect on the care of medical inpatients. If replicated in other settings, these findings might have important implications for medical educators and quality improvement initiatives.

Clinical Competence↗

PubMed2002

Comparison of breast mammography, sonography and physical examination for screening women at high risk of breast cancer in taiwan.

Recommended surveillance for screening breast cancer, which includes regular mammography and clinical breast examination, has long been established in Western countries. This strategy may be too costly and unnecessary for countries with low incidences of breast cancer. The purpose of the present study is to compare breast mammography, sonography and physical examination in screening female relatives of breast cancer index cases from the hospital, and their relative efficiency. A total of 935 women over 35 years old, who were relatives of breast cancer patients, were invited to an annual screening by means of a combination of mammography, sonography and physical examination on a single day. A biopsy was performed when any of the three investigations indicated a possibility of malignancy. A total of 21 breast cancers, including sixteen invasive cancers and 5 noninvasive cancers, were detected among the 935 high-risk women. Of the cancers, 18, including 16 invasive cancers and 3 noninvasive cancers, were detected by sonography. In contrast, only 11 invasive cancers were detected by mammography, and 7 by physical examination. There were only 14 cancers detected by a combination of mammography and physical examination. The 7 (33.3%) additional cancers were detected when sonography was added. The sensitivity of sonography was 90.4%, which was higher than mammography (52.4%) and physical examination (33.3%), or even a combination of these two modalities (66.7%). This indicates that sonography is a more accurate screening tool for breast cancer in the high-risk group. Although breast sonography has not yet been recommended as a routine screening tool for breast cancer in Western countries, it may be superior to mammography and physical examination for the screening of Taiwanese high-risk female relatives of breast cancer index cases. If it should also be considered as a routine adjunct screening modality for Taiwanese women with lower rates of breast cancer will need further study.

Adult↗

PubMed1994

Assessment of basic physical examination skills of internal medicine residents.

BACKGROUND: Internal medicine faculty at the Mayo Clinic designed a clinical evaluation exercise that separates assessment of physical examination skills from that of medical interviewing and reasoning skills. This report summarizes the first year's experience with assessment of basic physical examination skills. METHOD: A core faculty of five general internists and three internist subspecialists designed a 45-item general examination checklist (e.g., measure blood pressure, examine mouth, palpate liver, drape to ensure privacy). In addition, the core faculty generated a menu of 27 focused examination skills (e.g., examine for carpal tunnel syndrome) from which the faculty examiner would select five items for the resident to perform. Each checklist item was scored 0, 1, or 2 for a maximum possible score of 100. The core faculty selected a criterion-based scoring reference and established a passing score of 90 based on practice examinations with residents and faculty. The core faculty made an instructional videotape of a model examination that was available to all residents. In 1991-92, prior to examination, the checklist was distributed to all first-year categorical (43), preliminary (25), and newly appointed second-year residents (eight). RESULTS: Of the 76 residents examined, 11 (14%) failed and 65 (86%) passed. All failing scores were 86 or lower. The absence of scores 87, 88, and 89 suggested that faculty upgraded borderline performances. All 11 residents who initially failed retook the examination and passed. The five most commonly missed items were (1) inspect the skin, (2) complete examination in logical sequence, (3) palpate aorta, (4) auscultate anterior breath sounds, and (5) palpate axillary and inguinal nodes. Other important observed errors were failure to measure vital signs, confusion of liver and spleen, failure to use bell on stethoscope, and inadequate breast examination. Twenty-eight residents completed an optional feedback form. Reviews were mixed but generally favorable. CONCLUSION: Assessment of the basic physical examination skills of the internal medicine residents was useful, and such skills were able to be assessed separately from physical diagnosis skills and interviewing skills. Direct observation of basic physical examination skills revealed important deficiencies, which provided opportunity for remediation.

Adult↗

PubMed1997

[Demand for neuropediatric services at a general referral hospital. IV. Psychomotor development and physical examination].

INTRODUCTION AND OBJECTIVE: Diagnosis in neuropediatrics requires a detailed personal and family history and thorough physical examination. In this paper we study the psychomotor development and physical examination of children evaluated during a 5 year period, from May 1990 to May 1995 by a neuropediatrician newly appointed to the Hospital Miguel Servet in Zaragoza, which previously did not have such a specialist. RESULTS: Psychomotor retardation was seen in 19% of the children. In 50% of the children evaluated, significant data was obtained from the physical examination. The commonest finding, observed in 14% of the children, was of anomalous behaviour or an impression of mental deficiency. In decreasing order of frequency other data were: Diffuse pyramidal involvement, cranial nerve involvement, anomalous phenotype, microcephaly, microsomy, signs of neuromuscular involvement, hemiparesia, macrocephaly, skin markings, scoliosis, signs of extrapyramidal involvement, signs of cerebellar involvement, macrosomy and sensory disorders. CONCLUSIONS: Diagnosis in neuropediatrics is directed or established, sometimes exclusively, by an extensive personal and family history and adequate interpretation of this, which in the end depends on the skill of the clinician.

Child↗

PubMed1999

Predictive value of history and physical examination in patients with suspected ectopic pregnancy.

STUDY OBJECTIVE: To identify historical and physical examination findings that are predictive of ectopic pregnancy (EP) in pregnant patients with abdominal pain or bleeding. METHODS: This study was conducted in an urban academic emergency department as a prospective observational study of consecutive patients from August 1, 1991, to August 31, 1992, who had abdominal pain or vaginal bleeding and a positive beta-human chorionic gonadotropin level. Patients were excluded if they had a diagnostic ultrasound during a previous visit, or if the uterine size was larger than 12 weeks by pelvic examination. Data were analyzed using chi2 with a P value less than. 05 identified as significant. Odds ratios were determined for significant variables. A classification and regression tree analysis was then performed using the predictive variables to derive a decision tree. RESULTS: Four hundred forty-one patients were enrolled, 57 of whom (13%) had an EP. Factors by history that increased the risk of EP included pain that was described as moderate to severe, lateral, or sharp. Pain located in the midline decreased the risk of EP. A history of previous intrauterine device use, infertility, prior pelvic surgery, or tubal ligation were each found to be predictive. On physical examination, the presence of peritoneal signs, cervical motion tenderness, or lateral or bilateral abdominal or pelvic tenderness increased the risk of EP. A uterine size larger than 8 weeks by pelvic examination decreased the risk of EP. Combinations of predictive variables identified subsets of patients with either an increased or decreased frequency of EP, but in no case was a combination identified that would confirm or exclude this diagnosis with a high degree of certainty. CONCLUSION: History and physical examination findings predictive of EP were identified. However, no constellation of findings could confirm or exclude this diagnosis with a high degree of reliability.

Abdominal Pain↗

PubMed2004

["The girls are sick, weak and overstrained" Sickness among girls and boys based on Swedish physical examinations ca 1870-1930].

In the late 19th century a major physical examination of more than 11000 pupils was carried out in Swedish schools. There was a common belief among physicians and teachers that the current education had a most damaging influence on the health of boys and in particular girls. It was a well-known fact, according to some physicians, that a substantial number of Swedish girls suffered from diseases such as chlorosis and other ailments. Girls from the middle and upper classes were supposed to be the most affected. Based on the presumptions and observations, several physical examinations were preformed between 1870-1930. Swedish pupils were in a bad condition indeed. In the late 19th century more than 60 percent of all female students were in some way sick or in a bad condition. In comparison, 45 percent of all boys were not well. Most girls and boys were overstrained, anemic, suffered from headaches and had a poor appetite.A number of changes in the sickness and health of girls and boys during the period studied have been discovered. First, concepts of sickness and health were modified over time. What was defined as a sickness in the late 19th century was not interpreted in the same way a few decades later; Secondly, the prevalence of sickness in girls and boys changed over time. In the beginning of the period studied girls were sicker than boys, but in the end, in the 1930s, there was no obvious gender difference in the prevalence of sickness. In addition this article shows how the common belief, that middle and upper class girls were more exposed to and affected by illnesses, was not supported by the results from the contemporary physical examinations. Instead, it was evident that working class girls, in general, were sicker than boys with the same socio-economic status and also sicker than middle and upper class girls.

Child↗

PubMed2001

Clinical anatomy and the physical examination part I: thorax, abdomen, perineum, and pelvis.

This paper by the Educational Affairs Committee of the American Association of Clinical Anatomists (AACA) is a sequel to one published earlier, "A Clinical Anatomy Curriculum for the Medical Student of the 21st Century: Gross Anatomy" (AACA. 1996, Clin Anat. 9:71-99). In that curricular document a number of clinical procedures that apply gross anatomy to current medical practice are cited, including procedures related to the physical examination. This paper describes numerous anatomically based procedures that are performed during a physical examination to demonstrate that (1) gross anatomy forms a fundamental basis for physical diagnosis and (2) such an anatomic basis is delineated in our previously published curricular document. The AACA Educational Affairs Committee also hopes that the examples presented here will serve as a starting point for incorporating elements of the physical examination within a clinical anatomy curriculum in gross anatomy at the medical school level. This paper focuses on the physical examination of the thorax, abdomen, perineum, and pelvis; a subsequent paper will treat the physical examination of the limbs, back, head, and neck.

Abdomen↗

PubMed1998

Long-term outcome of patients who undergo tonometry as part of a general physical examination.

OBJECTIVE: To determine the value of including tonometry as part of a general physical examination. MATERIAL AND METHODS: Between Feb. 14, 1977, and Dec. 31, 1980, 849 residents of Rochester, Minnesota, underwent measurement of intraocular pressure by trained ophthalmic technicians at the request of a nonophthalmologist physician as part of a general physical examination. In 1995 and 1996, these cases were reviewed to determine how many patients in this study cohort had subsequently been diagnosed as having glaucoma. The outcome was derived from the examination of medical records and from the responses to mailed questionnaires and telephone interviews with study patients and their physicians. RESULTS: In patients whose intraocular pressures were less than 16 mmHg at baseline, the risk of being diagnosed as having glaucoma within 10 years was 1% (95% confidence interval [CI], 0 to 2%) and within 15 years was 2% (95% CI, 0 to 4%). In patients whose pressure in the higher-pressure eye was 16 to 21 mmHg at baseline, the risk of having glaucoma in 10 years was 3% (95% CI, 2 to 5%) and in 15 years was 5% (95% CI, 3 to 7%). Twenty-four patients were found at baseline to have an intraocular pressure of 22 mmHg or higher in at least one eye or a difference of 5 mmHg or more between the two eyes. In this group, the risk of having glaucoma in 10 years was 17% (95% CI, 0 to 31%) and in 15 years was 26% (95% CI, 6 to 43%). CONCLUSION: When included as part of a general physical examination of older persons, tonometry and a few simple questions provide information that can be used to help the clinician determine the advisability of more detailed ophthalmic examinations.

Adult↗

PubMedDate not supplied

A CD-ROM tutorial for physical examination.

In 1998 the Committee for University Teaching and Staff Development (CUTSD) awarded a grant of $47,975 to develop an interactive CD-ROM tutorial program to facilitate teaching the process of physical examination of the abdomen, lungs and thorax, to students of nursing. This program was developed to complement current teaching methods and make it possible for tutors to use the available class time to further address students' individual learning needs. It was developed to enable flexible delivery of content, to provide a front seat view of the demonstration of the procedures, and simulated practice opportunities in the safety and privacy of computer simulation. The program was not intended to replace hands-on practice as this learning medium does not address the kinaesthetic component of performing physical examination but it is expected to hasten the development of confidence in practice by strengthening the user's knowledge of the techniques and the sequence of physical examination. Through providing the opportunity to elicit inspection, palpation, percussion and auscultation examination findings in the context of 10 case studies of patients with health problems, it is also expected to facilitate recognition of abnormalities and their significance for health care students who have little clinical experience. The program has been evaluated by senior nursing students for technical problems, effectiveness as a learning aid and user friendliness. Over all, 92% (n=38) of the students considered that the program assisted them to learn physical examination of the abdomen, thorax and lungs and 95% were satisfied with the quality of the product and found that the sounds and images helped their understanding. The content of the program was considered to be logically sequenced, to have assisted understanding, and the case studies were a valuable learning aid. The evaluation data from this trial also indicates that students would like to learn about physical examination of other body systems using this medium.

Attitude of Health Personnel↗