A core physical examination in internal medicine: What should students do and how about their supervisors?

Abstract

Background: Performance of a focused physical examination will induce a high cognitive load for medical students in the early phase of the clinical clerkships. Aim: To come to a workable and clinically applicable standard physical examination for medical students to be used in every new patient in the daily clinical practice of internal medicine. Method: A questionnaire held among physicians that supervise students during the clerkship of internal medicine in one Dutch training region. Results: Of the complete list of physical examination 55 items were considered to be an integral part of the standard general physical examination for medical students. Most emphasized were elements of the physical examination aimed at general parameters, thorax and abdomen, vascular status, lymph nodes, spinal column, skin and some parts of the neurological examination. The standard physical examinations performed by supervisors themselves contain fewer items than they expected from the students. The expectations a supervisor has towards the student correlates with the frequency with which they apply the various components in their own physical examination. Conclusion: This study provides us with a 'core' physical examination for medical students that can be applied in the early phase of the clinical clerkships.

Assessment of junior doctors’ admission notes: do they follow what they learn?

“…It is worth noting that not all interns and residents included in this study attended the KAU Faculty of Medicine, and this study did not compare the notes of those who studied at KAU with those who did not. However, the concept of following a standard comprehensive approach is taught to medical students universally; 5 , 23 any variations should be minor and should not significantly change our findings.…”

“…They are also crucial for the completeness of the medical record, which is a fundamental tool in patient care in the hospital setting 3 . For these reasons, medical students in their clinical years are taught to take a standard comprehensive history and perform a thorough physical examination for all patients at the time of admission 4 , 5 . Junior doctors who initially encounter and assess patients at the time of admission and write initial assessment notes for those patients are accordingly expected to follow that comprehensive approach.…”

A Core Physical Exam for Medical Students

“…Previous work on developing a core exam includes a recently published study from the Netherlands, where Haring et al 18 found that educators at their institution (13) .03 Visual acuity 24 (14) 18 (20) 6 (7)…”

The value of the physical examination in clinical practice: an international survey

“…The novel and simple ranking of PESM according to their frequency and usefulness used in this study may assist educators in focusing on the teaching and assessment those of highest perceived value in clinical curricula 9 and provide clinical researchers with a focus for future studies of diagnostic accuracy, either of physical examination alone or in comparison to or in conjunction with other diagnostic modalities, that, if combined with cost effectiveness data, might inform future diagnostic strategies. 17 …”