title: Introduction of structured physical examination skills to second year undergraduate medical students.
abstract: BACKGROUND
  Effective learning of physical examination skills (PES) requires suitable teaching and learning techniques and assessment methods. The Tribhuvan University (Nepal) curriculum recommends involving the departments of Medicine and Surgery in PES training (PEST) for second year students as a part of early clinical exposure. The project was developed to make teaching/learning of PES structured, involving eight clinical sciences departments and using appropriate methods for teaching and assessment in KIST Medical College, Nepal.
  
  
  METHODS
  Irby's three stages of clinical teaching model (Preparation, Teaching, Reflection), was applied for teaching. Skill acquisition was based on Millers' learning pyramid at "show how level" and Dreyfus' competency model at "competent level". Teaching/learning was conducted in small groups. A tutorial, demonstration and practice (TDS) model was developed for teaching/learning techniques based on a simple five-step method for teaching clinical skills. Assessment of effectiveness of training was done at "reaction level" as per Kirkpatrick's model based on students' feedback, "shows how level" as per Miller's pyramid of learning by OSCE and "competent level" as per Dreyfus' model using retro-pre questionnaire.
  
  
  RESULTS
  The analysis of retro-pre questionnaire based on the Dreyfus model found the average skill score (max score 184), before the introduction of the project module as 15.9 (median = 13.5) and after as 116.5 (median = 116). A paired t-test showed the difference to be statistically significant (100.5±23 and 95% CI 95.45 - 105.59). The average overall feedback score for the students on PES training based on seven items on a five point Likert scale was found to be 4.30. The mean total objective structured clinical examination (OSCE) score was 3.77 (SD+/- 0.33) out of 5; 80% of students scored more than 70%.
  
  
  CONCLUSIONS
  Students learned most of the skills with the implementation of the structured PES module and did well in the OSCE. Students and faculty were satisfied with the training and assessment.
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Rano M
authors.initials: RM
authors.lastname: Piryani
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: P Ravi
authors.initials: PR
authors.lastname: Shankar
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Trilok P
authors.initials: TP
authors.lastname: Thapa
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Bal M
authors.initials: BM
authors.lastname: Karki
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Rishi K
authors.initials: RK
authors.lastname: Kafle
authors.affiliation: KIST Medical College, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Mahesh P
authors.initials: MP
authors.lastname: Khakurel
authors.affiliation: Patan Academy of Health Sciences, Lalitpur, Kathmandu Valley, Nepal.
authors.forename: Shital
authors.initials: S
authors.lastname: Bhandary