title: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Medicine, Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA. sramani@bu.edu
authors.forename: Subha
authors.initials: S
authors.lastname: Ramani
mesh_terms: D001291:Attitude of Health Personnel; D002983:Clinical Competence; D015510:Clinical Medicine / Q000193:education*; D003162:Competency-Based Education; D004501:Education, Medical / Q000379:methods*; D006801:Humans; D016544:Patient Simulation; D010808:Physical Examination / Q000379:methods*; D010817:Physician-Patient Relations; D012577:Schools, Medical; D013663:Teaching / Q000379:methods*; D014861:Washington