Medical Skills in a Clinical Presentation-based Curriculum - Approach to the Patient with Acute Fever

Publication ID Published Volume
9842 July 9, 2014 10

Abstract

The materials in this submission guide clinical faculty as they organize and present two sequential learning sessions that teach pre-clerkship medical students the clinical workup of the acutely febrile patient. The first session is a small group learning activity with clinical faculty members and demonstration patients. Students are coached as they practice the steps of the focused physical examination of the acutely febrile patient. During the second session, students individually (or in pairs) work through the interview and perform the examination of a standardized patient presenting with acute fever. After this encounter, students write a SOAP note, receive feedback from the standardized patient (and from their peer observer, if present) and debrief in a group discussion with a faculty member.

For the first session, the submitted materials include a preparatory physical exam worksheet and accompanying video. For the second session, the materials include a readiness assurance quiz, preparatory exam room guide and video, summary outline that students can use during the standardized patient encounter, a check sheet to guide peer observer feedback, and a standardized patient case blueprint. There is an optional Spanish-language translation of the patient interview for medical schools with a Spanish speaking patient population.

These materials would be of interest to pre-clerkship clinical skills instructors who would like to teach a presentation-based, focused history and physical exam to their trainees. These materials were originally developed for the Medical Skills Course at the Texas Tech University Paul L. Foster School of Medicine (PLFSOM) in El Paso, Texas. The pre-clerkship curriculum at the PLFSOM is a fully integrated, clinical presentation-based curriculum. This curricular structure allows clinical skills instruction to be tightly integrated with basic science content. Therefore, it is important to situate these two sessions at a point in the curriculum when appropriate basic science content has been covered.

During the first semester of medical school, most medical students have their first precepted clinical experiences. For medical students to participate effectively in these experiences, they need a set of basic clinical skills coupled with a fundamental understanding of how to apply those skills to a clinical problem. The problem of the patient with acute fever is a good platform for building this basic set of skills. Acute fever a common problem that students will encounter many times, making this a highly relevant learning experience.

History taking this structured around a framework of eight common sites of infection, which helps students organize their interview and decreases the perception of “information overload”. The eight potential sites of infection are distributed widely throughout the body, leading students to perform a physical exam that spans a number of organ systems. The basic set of exam skills covered in this exercise are generally useful and widely applicable to other clinical presentations.

The instructional approach incorporates sequenced, incremental development of physical exam skills that are initially practiced with coaching and guidance from an experienced clinical faculty member. Subsequently, students perform the interview and physical exam independently in the setting of a moderately complex clinical problem. The diagnosis for the patient case is selected because symptoms are present in multiple organ systems, making all of the components of the physical exam relevant during the SP encounter.

Citation

Woods G. Medical skills in a clinical presentation-based curriculum - approach to the patient with acute fever. MedEdPORTAL Publications. 2014;10:9842. http://doi.org/10.15766/mep_2374-8265.9842

Educational Objectives

  1. Effectively use verbal communication to warmly greet the patient, establish a positive atmosphere and clarify the purpose of the visit.
  2. Effectively use non-verbal communication skills such as eye contact, attentive body posture, comfortable spatial positioning to establish a supportive initial relationship with the patient.
  3. Use open-ended and directed questioning to obtain the history of present illness, check for localizing symptoms, and check for red flag symptoms that might indicate severe illness.
  4. Use correct technique to examine the ears, nose, throat, and to palpate the lymph nodes of the neck, using the findings to narrow the list of diagnostic possibilities.
  5. Use correct technique to examine the lung fields; listening to inhalation and exhalation at all eight locations on the back and two locations on the front, using the findings to narrow the list of diagnostic possibilities.
  6. Use correct technique to examine the heart sounds at four locations on the chest, using the findings to narrow the list of diagnostic possibilities.
  7. Use correct technique to palpate the abdomen and suprapubic area, using the findings to narrow the list of diagnostic possibilities.
  8. Provide effective closure at the end of the encounter by summarizing the findings, recommending next steps, and planning for follow up.

Keywords

  • Communication Skills, Clinical Decision-Making, Clinical Skills, Physical Examination Skills, Diagnostic Decision-Making, Infectious Diseases, Communicable Disease, Medical Record Documentation

Material Access

Please sign in to access this material.

Please register for an AAMC account if you do not have one.

Register

  • Contact Us

ISSN 2374-8265