P186 The reliability of the respiratory physical examination

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We often teach and assess medical students performing the respiratory examination in a traditional way, rather than based on evidence. An essential component of the respiratory clinical examination is that it is precise. The reliability of the examination is a fundamental element of this precision. There needs to be agreement between physicians that a clinical sign can be elicited independently in the same patient when it is present. When learning about the respiratory examination, medical students should have knowledge of the reliability of the different elements.


To establish medical students' knowledge of the reliability of different elements of the respiratory examination.


A cross sectional questionnaire survey of clinical medical students (years 3–5) was undertaken. The questionnaire assessed the reliability of tactile vocal fremitus, tracheal position, auscultation of wheeze, whispering pectoriloquy, auscultation of crackles and chest expansion using a five point Likert scale. Demographic data were also collected. The results of the perceived reliability of different elements of the respiratory examination was compared with Cohen's κ coefficient values; a statistical measure of inter-observer reliability.


Of 104 questionnaires completed, 33% were male, 36% attached to respiratory firm, 11% graduate entry. Crackles, wheeze and percussion note are all regarded as reliable to very reliable signs by students. Perceived reliability of whispering pectoriloquy decreased as students become more experienced (p=0.003). There was no relationship between perceived reliability and graduate entry, previous respiratory attachment or gender. Factor analysis identified that tactile vocal fremitus and whispering pectoriloquy were grouped together separately from the other respiratory signs. Linear regression showed good correlation between students answers and actual κ values of reliability (r=0.722).


Students have a good intuition of the reliability of elements of the respiratory examination. For example, as experience increases, they correctly perceive whispering pectoriloquy as a less reliable sign. Reliability of elements of the respiratory examination needs consideration when teaching and assessing students.

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