Teaching the physical examination by context and by integrating hand-held ultrasound devices

Abstract

Although practiced to this day, teaching the ‘head-to-toe’ physical examination (PE) does not appear to fully achieve its objective, and since the 1970s, there have been proposals to replace the traditional teaching of the head-to-toe examination by a selective PE aimed at testing diagnostic hypotheses; by a core PE to be supplemented by additional maneuvers as clinically indicated; and by limiting the number of PE maneuvers to be taught. The need to update the teaching of the PE is further indicated by the availability of hand-held pulse oximeters, spirometry and especially point of care ultrasound devices (PoCUS). This paper is a call to update the introduction of medical students into the PE by (a) teaching the PE by clinical contexts, rather than by organ systems, (b) restricting the number of PE maneuvers by discerning between a core of ‘essential’ PE signs of urgent conditions, ‘important’ signs that should supplement the core as clinically indicated, and ‘optional’ PE signs that are no longer useful, and (c) combining previously proposed alternatives of the traditional head-to-toe PE with application of hand-held ultrasound devices. We provide examples of essential, important and optional signs of the cardiovascular system.

Keywords:

• Medical education
• physical examination
• basic clinical skills
• PoCUS

Disclosure statement

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the article.

Glossary

Physical (medical, clinical) examination of a patient: A procedure performed by a medical practitioner in order to detect possible symptoms and signs of a medical condition. It consists of listening to the patient's medical history and an examination by observation, palpation, percussion and auscultation using a stethoscope, ophthalmoscope, otoscope, sphygmomanometer, tuning fork, hammer, pulse oximeters, spirometers and point of care ultrasound.

Additional information

Notes on contributors

Jochanan Benbassat

Jochanan Benbassat is a research associate at JDC Meyers-Brookdale Institute since retiring in 1998. Formerly, he was Professor of Medicine at the Hadassah University Hospital in Jerusalem. In 1982 he was appointed director and Chair of the Department of Medical Education of the Hebrew University and Hadassah Faculty of Medicine. In 1992-1997, he headed the department of Sociology of Health and chair of Behavioral Sciences in Medicine at the Faculty of Health Sciences in Beer-Sheva.

Dan Gilon

Dan Gilon is Professor of Medicine at the Hadassah University Hospital and Director of the Non-Invasive Cardiology and Cardio-Oncology units. He was the founder and first Chairman of the Israel Working Group of Echocardiography; Vice-Dean of the Faculty of Medicine for Students affairs (2000-2005) and Promotions (2009-2013). Currently he serves on the Faculty’s promotion committee and the Hadassah University Hospital IRB committee, and is a member of the International Registry of Aortic Dissection (IRAD) and of the International Multicenter consortium of Bicuspid Aortic Valve (BAVCON).

Both Drs Gilon and Benbassat have tutored medical students throughout their service as residents and attending physicians at the Hadassah University Hospital in Jerusalem.