Introduction: 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 as it is a problem that students will encounter many times. Methods: 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. The preparatory physical exam worksheet and accompanying video are included. During the second session, students individually (or in pairs) work through the interview and perform the examination of a standardized patient (SP) presenting with acute fever. The readiness assurance quiz, preparatory exam room guide and video, student summary outline, peer observer feedback guide, and a SP case blueprint are included. There is an optional Spanish-language translation of the patient interview. After the SP encounter, students write a SOAP note, receive feedback from the SP (and from their peer observer, if present) and debrief in a group discussion with a faculty member. Results: These session materials have been used for 5 years with 500 students. With 100 students in each class, the activity is presented six times over the course of a day to groups of 17 students. Discussion: These materials would be of interest to preclerkship clinical skills instructors who would like to teach a presentation-based, focused history and physical exam to their trainees. The preclerkship curriculum at the Texas Tech University Paul L. Foster School of Medicine is a fully integrated, clinical presentation-based curriculum, which 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.
- Effectively use verbal communication to warmly greet the patient, establish a positive atmosphere, and clarify the purpose of the visit.
- Effectively use nonverbal communication skills such as eye contact, attentive body posture, and comfortable spatial positioning to establish a supportive initial relationship with the patient.
- 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.
- Use correct technique to examine the ears, nose, throat, and to palpate the lymph nodes of the neck.
- 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.
- Use correct technique to examine the heart sounds at four locations on the chest.
- Use correct technique to palpate the abdomen and suprapubic area.
- Provide effective closure at the end of the encounter by summarizing the findings, recommending next steps, and planning for follow up.
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