A new method for teaching physical examination to junior medical students

Figures & data

Table 1 Henry’s presenting complaint

A 46-year-old male presents to you, the GP, complaining of an extremely painful left foot, which came on after he stubbed it jousting yesterday. What do we want to know?

Abbreviation: GP, general practitioner.

Table 2 Exploring Henry’s presenting complaint

S – He says the pain started in his left toe

O – It started about an hour ago

C – The pain is throbbing

R – The pain does not go anywhere else

A – He has noted some hard nodules on his hands and ear

T – The pain is constant

E – Nothing makes it worse

S – He describes the pain as severe

Notes: SOCRATES, Sight, Onset, Characteristics, Radiation, Associated factors, Timing, Exacerbating Factors, Severity.

Table 3 Exploring Henry’s history

PMHx: Probable diabetes, hypertension, and kidney failure

PSHx: None

Allergies: NKDA

Medications: On a diuretic for his hypertension, uses St John’s Wort and Achinesia regularly

Family history: He remembers his dad, Henry VII, having a similar problem

Social history: Smokes 15/day, drinks 30 units a week

Abbreviations: PMHx, patient medical history; PSHx, past surgical history; NKDA, no known drug allergies.

Table 4 Examining Henry’s foot and ankle

Look

1. Expose lower limbs

2. Note walking aids, do bedside inspection

3. Examine footwear adaptations

4. Inspect front, sides, back, and gait

5. Ask patient to stand on toes, look for muscle wasting

6. Look for swellings, deformities, and muscle wasting

Feel

1. Ask about pain

2. Assess skin temperature over both feet

3. Look for areas of tenderness

4. Squeeze MTPJs

5. Palpate any swelling, edema, or lumps

Move

1. Active and then passive movements

2. Ankle dorsiflexion, plantar flexion, inversion, and eversion

3. Toe flexion, extension, abduction, and adduction

Abbreviation: MTPJs, metatarsophalangeal joints.

Table 5 Review question

Which of the following are risk factors for gout? (pick three)

a. Obesity [correct]

b. Bendroflumethiazide [correct]

c. Furosemide

d. Mannitol

e. Malnourishment

f. High-protein diet [correct]

g. High-carbohydrate diet

h. High-dairy diet

Figure 1 Development of the teaching session.

Notes: The red text denotes structural and content changes made to teaching session throughout development. From the first session to the last.
Abbreviation: MCQ, multiple-choice question.