Sunday, March 2, 2014

Practice makes perfect: Physical exam rounds as an education tool

It is a great feeling in ASCM1 to learn the myriad of physical exam maneuvers available for each organ system, and then to practice them with painstaking detail on willing patients every week. I remember poring over the handbook, trying to accurately perform every exam possible for a given system and not missing a single test. Then clerkship happened; it is all too easy to forget the less performed physical exam maneuvers with each passing rotation.

This is why it is always a nice experience to participate in physical exam rounds. Once or twice a month, groups of learners are taken to a patient, and can either observe or be put on the spot and demonstrate a particular set of physical exam maneuvers (such as aortic stenosis, chronic liver disease, etc.). Along the way, the staff or chief resident leading the session adds additional information to ensure a complete examination is performed, and the remaining residents and clerks have a chance to participate or clarify any questions they have.

These sessions of group bedside teaching are a great addition to the medical education experience. It is a chance to learn about the most up-to-date, evidence-based physical exam for a particular disease or organ system. For the residents, it is a good chance to perfect their clinical exam skills in preparation for the Royal College exam (each session has a corresponding Rational Clinical Exam article). For the clerks, it is a good opportunity to re-visit the physical exam, and how to perform it more thoroughly and properly. Not only is it important to re-learn the content of the physical exam, but the finesse involved (proper positioning, smooth transitions between exam maneuvers, learning how to present findings while performing the physical exam, etc.) are vital skills for an OSCE and for gaining more confidence for gaining clinical acumen in the future.

- Anthony

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