A new method for teaching physical examination to junior medical students

Abstract

IntroductionTeaching effective physical examination is a key component in the education of medical students. Preclinical medical students often have insufficient clinical knowledge to apply to physical examination recall, which may hinder their learning when taught through certain understanding-based models. This pilot project aimed to develop a method to teach physical examination to preclinical medical students using “core clinical cases”, overcoming the need for “rote” learning.MethodsThis project was developed utilizing three cycles of planning, action, and reflection. Thematic analysis of feedback was used to improve this model, and ensure it met student expectations.Results and discussionA model core clinical case developed in this project is described, with gout as the basis for a “foot and ankle” examination. Key limitations and difficulties encountered on implementation of this pilot are discussed for future users, including the difficulty encountered in “content overload”.ConclusionThis approach aims to teach junior medical students physical examination through understanding, using a simulated patient environment. Robust research is now required to demonstrate efficacy and repeatability in the physical examination of other systems.

A scoping review of practical approaches to teaching clinical examination in UK undergraduate medical education

“…Four papers were published between 2005 to 2013 describing teaching interventions that have been applied or developed for UK undergraduate medical students ( Figure 1 and Table 2) (Kilminster et al, 2001;Raj et al, 2006;Swamy et al, 2013;Sayma and Williams, 2016). Studies are from secondary care settings.…”

“…Two articles investigated the benefits of simulation or computer aided learning to teach clinical examination (Vivekananda-Schmidt et al, 2005;Swamy et al, 2013;Sayma and Williams, 2016). Swamy et al conducted a crossover study where groups were taught chest examinations on either a simulation model or by practicing on one another, then each group swapped.…”

“…Proper CE is shown to reduce the risk of medical errors and prevents inappropriate use of diagnostic testing and imaging (Verghese et al, 2015;Elder, Japp and Verghese, 2016). Effective and appropriate CE aids doctor-patient relationship, patient safety and the efficiency of medical treatment (Zolnierek and Dimatteo, 2009;Sayma and Williams, 2016). Whereas inadequate CE has the potential to cause inaccurate diagnoses, delayed treatment and unnecessary radiological or clinical tests (Schiff et al, 2009).…”

“…Teaching of CE is integrated into medical curricula from the first years of study and competencies are regularly assessed (Bradley, 2002;Sayma and Williams, 2016). However, observational studies find that after the third year of undergraduate education confidence in CE barely increases and another show final year students already begin to cut their CE short (Wu et al, 2007;Haring et al, 2014).…”

Rote learning: a necessary evil

“…We read with great interest the short report by Sayma and William 1 exploring the teaching of physical examinations to junior medical students. The article highlights many salient points in aiding the memory and understanding of practical medicine and preparation of the clinical years ahead for preclinical medical students.…”