Twelve tips for excellent physical examination teaching

Abstract

Background: Physical examination (PEx) skills are declining among medical trainees, yet many institutions are not teaching these systematically and effectively. Many variables contribute to effective teaching: teachers’ confidence in their clinical skills, ability to demonstrate and assess these skills; availability of suitable patients; trainee attitude and fatigue; belief that institutions do not value clinical teachers. Finally, the relevance and significance of a systematic exam must be demonstrated or the teaching degenerates into a ‘show-and-tell’ exercise.

Aims: This paper describes twelve practical teaching tips that can be used to promote high quality PEx teaching in 5 minutes or 45 minutes.

Teaching tips: (1) Diagnostic hypotheses should guide reflective exam; (2) Teachers with the best clinical skills should be recruited; (3) A longitudinal and systematic curriculum can tailor teaching to multiple learner levels (4) Integration of simulation and bedside teaching can maximise learning; (5) Bedside detective work and games make learning fun; (6) The 6-step approach to teach procedures can be adopted to teach PEx; (7) Clinical teaching at the bedside should be increased; (8) Linking basic sciences to clinical findings will demonstrate relevance; (9) Since assessment drives learning, clinical skills should be systematically assessed; (10) Staff development can target improvement of teachers’ clinical skills for effective teaching; (11) Technology should be used to study utility of clinical signs; (12) Institutions should elevate the importance of clinical skills teaching and recognize and reward teachers.

Conclusions: PEx is important in patient-physician interactions, a valuable contributor to accurate clinical diagnosis and can be taught effectively using practical tips. To reverse the trend of deficient clinical skills, precision of clinical findings should be studied and exam manoeuvres that do not contribute to diagnosis discarded; institutions should value clinical skills teaching, appoint and fund core faculty to teach and provide staff development to improve teaching skills.

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Subha Ramani

SUBHA RAMANI, MBBS, MMEd, MPH. Dr. Ramani is a general internist and medical educator. She is an Associate Professor of Medicine at the Boston University School of Medicine and directs Clinical Skills Development for the Internal Medicine Residency Program. She has completed a Masters in Medical Education at the University of Dundee. Her major areas of interest in medical education include clinical skills teaching and assessment, clinical teaching methods and staff development in teaching.