Step-by-Step Training Video and Manual for the Physical Examination
|9046||December 6, 2011||1|
Hospitalized patients appropriate for teaching physical examination to medical students have been increasingly difficult to secure - sicker patients and shorter hospital stays. Physicians are also under pressure to generate revenue, leaving less time for non-revenue generating activities such as supervising medical students. To proactively address the above concerns, the course faculty at Wayne State University School of Medicine decided to implement a program of using standardized patients to supplement the teaching of physical diagnosis.
This program lets students learn and practice their physical examination skills in a less stressful, more predictable, standardized environment and provides them with individualized instruction. It allows the students the ability to practice repeatedly and to obtain feedback from the SPTA about their technique.
This resource includes a comprehensive Step by Step guide (video and SPTA teaching materials) for teaching the basic physical exam.
Note: This resource consists of separate pieces of content. You may need to access via website, download resource files and/or request additional information from MedEdPORTAL staff to access the full publication.
Afonso N, Schwartz L, Brennan S. Step-by-Step Training Video and Manual for the Physical Examination. MedEdPORTAL Publications; 2011. Available from: https://www.mededportal.org/publication/9046 http://dx.doi.org/10.15766/mep_2374-8265.9046
- To be familiar with the pertinent anatomy and physiology as it applies to the physical exam.
- To be familiar with the techniques necessary to perform a physical examination.
- Physical Examination
Practice-based Learning & Improvement
- Clinical Exam
- Medical Student
Authors & Co-Authors
Nelia Maria Afonso, MD, MB, MS, MRCP
Oakland University William Beaumont School of Medicine
Lawrence Roger Schwartz, MD, MEd, FACEP
Wayne State University
Simone Brennan, MA
Wayne State University School of Medicine
Effectiveness and Significance
Since 2004 years we have been using SPTAs help teach the physical exam to our preclinical medical students at Wayne State University. These materials have been very effective in standardizing the teaching for our large medical school class (~290 students). It has also allowed students acquire basic physical exam skills by practicing on SPTAs prior to their contact with real patients in the hospital setting. Trainees of other healthcare professions can also use this resource.
Special Implementation Guidelines or Requirements
Practical implementation advice:
- Materials needed: DVD player, Bates’ Guide to Physical Examination and History Taking (10th edition).
- Length of session: Review of video/ training materials (40 minutes), Practice session (1- 2 hours).
- Two students work with one SPTA. Each student is allowed to practice the physical examination on the SPTA while the other student follows along with the training manual. The students receive feedback from the SPTA regarding their technique.
- One faculty member is needed as supervisor to answer any questions related to the finer nuances of the physical exam as well as the clinical applications.
How has it been successfully deployed at Wayne State University?
- We have used SPTAs to train our medical students since 2004. Initial training of SPTAs is time consuming but once trained our cadre of SPTAs has successfully been used not only to train medical students, but is now also being used as raters for OSCEs and trainers for residents and other health care professionals.
- Training includes pre-circulation of the system-specific objectives given to students, a copy of training materials and video, a copy of the physical diagnosis textbook (Bates’2009) and other ancillary materials such as anatomy charts. SPTAs are trained on techniques of the physical examination and methods of instruction, by SP educators and one of the coordinating physicians/SPTA trainers. SPTAs are required to arrive prepared for group training sessions. Group training consisted of at least 6-8 hours of supervised interaction, practice, and testing per system. These sessions begin SPTAs dividing into groups of two or three to work and practice with each other under the guidance of staff and the physician. Each training session requires that all SPTAs both perform the appropriate physical examination and teach it to their peers. Before certifying them as competent for each system, the physician/SPTA trainer in charge individually assesses and if necessary, adjusts each SPTA’s technique. SPTAs are also required to provide a combination of guidance to a nervous, fumbling “student,” or correct “errors” in technique.
Physicians have several variations in the techniques of performing physical exam maneuvers – this tends to confuse beginner students and makes it difficult to standardize teaching. This resource is an attempt to standardize some of the discrepancies for beginners leaning how to perform a physical exam.
This resource does not address the rationale or the clinical applications of the physical exam technique. We hope to further the development of this as an online manual with links to appropriate resources that will be useful for medical students.
This information is made available under the Creative Commons license.