title: An appraisal of the literature on teaching physical examination skills.
abstract: OBJECTIVE
  To discover which models for teaching physical examination skills have been proposed, and to appraise the evidence for each.
  
  
  METHODS
  We conducted a narrative review of relevant literature from 1990-2010. We searched the databases MEDLINE, PsycINFO, and ERIC (The Education Resource Information Centre) for the terms: 'physical examination' AND 'teaching' as both MESH terms and keyword searches. We excluded web-based or video teaching, non-physical examination skills (e.g. communication skills), and articles about simulated patients or models.
  
  
  RESULTS
  We identified five relevant articles. These five studies outlined several approaches to teaching physical examination skills, including Peyton's 4-step model, an adaptation of his model to a 6-step model; the silent run through; and collaborative discovery. There was little evidence to support one method over others. One controlled trial suggested that silent run-through could improve performance of complex motor tasks, and another suggested that collaborative discovery improves students' ability to recognise key findings in cardiac examinations.
  
  
  CONCLUSIONS
  There are several models for teaching physical examinations, but few are designed specifically for that purpose and there is little evidence to back any one model over another. We propose an approach which adopts several key features of these models. Future research could usefully evaluate the effectiveness of the proposed models, or develop innovative practical models for teaching examination skills.
authors.affiliation: Department of Primary Care and Public Health, Imperial College London, London W6 8RP, UK. g.easton@imperial.ac.uk
authors.forename: Graham
authors.initials: G
authors.lastname: Easton
authors.forename: James
authors.initials: J
authors.lastname: Stratford-Martin
authors.forename: Helen
authors.initials: H
authors.lastname: Atherton
mesh_terms: D002983:Clinical Competence; D004504:Education, Medical, Undergraduate / Q000379:methods*; D017145:Models, Educational; D010808:Physical Examination / Q000379:methods*; D013663:Teaching / Q000379:methods*