Teaching the physical examination: a longitudinal strategy for tomorrow's physicians.
The physical examination is an essential clinical skill. The traditional approach to teaching the physical exam has involved a comprehensive "head-to-toe" checklist, which is often used to assess students before they begin their clinical clerkships. This method has been criticized for its lack of clinical context and for promoting rote memorization without critical thinking. In response to these concerns, Gowda and colleagues surveyed a national sample of clinical skills educators in order to develop a consensus "core" physical exam, which they report in this issue. The core physical exam is intended to be performed for every patient admitted by students during their medicine clerkships and to be supplemented by symptom-driven "clusters" of additional history and physical exam maneuvers.In this commentary, the authors review the strengths and limitations of this Core + Clusters technique as well as the head-to-toe approach. They propose that the head-to-toe still has a place in medical education, particularly for beginning students with little knowledge of pathophysiology and for patients with vague or multiple symptoms. The authors suggest that the ideal curriculum would include teaching both the head-to-toe and the Core + Clusters exams in sequence. This iterative approach to physical exam teaching would allow a student to assess a patient in a comprehensive manner while incorporating more clinical reasoning as further medical knowledge is acquired.
Dr. Uchida is director of clinical skills education, Clinical Education Center, Augusta Webster Office of Medical Education, and assistant professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois. Dr. Farnan is director of clinical skills education, medical director of the clinical performance center, and assistant professor, Section of Hospital Medicine, Department of Medicine, University of Chicago Pritzker School of Medicine, Chicago, Illinois. Dr. Schwartz is statewide course director, Introduction to Clinical Medicine II, Indiana University School of Medicine, and assistant professor of clinical medicine, Division of Hematology-Oncology, Department of Medicine, Indiana University, Indianapolis, Indiana. Dr. Heiman is medical director, Clinical Education Center, clinical medicine element chair, Augusta Webster Office of Medical Education, and assistant professor, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Toshiko
T
Uchida
Jeanne M
JM
Farnan
Jennifer E
JE
Schwartz
Heather L
HL
Heiman
D002982:Clinical Clerkship; D002983:Clinical Competence; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods*; D006801:Humans; D010808:Physical Examination / Q000379:methods* / Q000592:standards