MedEdPORTAL (Mar 2015)
Teaching Physical Exam Skills to Novices: Developing all the Tools in the Clinician Toolbox
Abstract
Abstract Introduction This resource is designed for use within a preclinical skills course to teach first and second-year medical students fundamental physical exam (PE) skills. PE skills are a vital competency for medical students to master. Since bedside teaching of the PE during clerkships is infrequent, students entering clerkships must have a strong foundation in PE skills that will enable them to function autonomously. Methods This resource helps students develop all the essential tools in their clinician PE toolbox. Students first learn a head-to-toe exam with associated provocative tests according to detailed checklists and PE videos that provide significant scaffolding for the novice learner. While detailed, the checklists and videos are designed to emphasize flexibility, and can expand or contract to a core exam based on what is needed for patient care. Once students have a firm foundation of PE skills, they can begin to learn to select the appropriate tools for the job by learning to perform hypothesis-driven physical exams as support is gradually diminished. Results The PE checklists and videos have been refined based on student and faculty feedback in an iterative process over more than 10 years of use at the Warren Alpert Medical School of Brown University. The color-coding schema with core/provocative tests was introduced last year and received very favorably. The effectiveness of physical exam instruction is consistently ranked at Brown as very good (4.7 out of 6.0 in 2014) on a scale from poor to outstanding. Discussion Clinical skills course directors wishing to develop a physical exam thread or seeking to improve their current PE instruction are likely to find this resource valuable. Although this resource was designed for medical students, physician assistant or nurse practitioner training programs may also find it useful.
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