Physical examination guru Dr. André Mansoor, @AndreMansoor brings his expertise to effectively teach the physical examination to learners! We discuss the power of the physical examination, how to prime learners for bedside teaching, and ways to solidify knowledge gained.
At times, physical examination can be more reliable than technology. Dr Mansoor shares examples including a patient with inflammatory arthritis who underwent surgical debridement because their psoriasis was missed.
Performing a hypothesis driven physical examination can help you arrive at the correct diagnosis more efficiently and thus, save you, your team, and the patient time (Balighian 2016). Avoid the shotgun approach to ordering tests and over utilizing technology (Zaman 2018).
We as educators must debunk the myth that physical examination is not helpful. Educators should seek to ignite a learner’s curiosity and appreciation for the physical examination.
Some resources Dr. Mansoor recommends to brush up on your physical examination skills include:
He also points out the value of having a colleague or peer that you can practice and discuss skills with.
Start with brief white board didactics followed by bedside teaching for a one-two punch. Didactics should be based on the physical examination finding the learner is about to encounter and how we as clinicians differentiate physical examination findings. Having the learner anticipate what they are going to see or hear allows them to be more likely to identify it (Balighian 2016). Additionally, the differential diagnosis for each physical examination finding should be discussed.
Then, go to the bedside! Teaching the physical examination must occur at the bedside for experiential learning.
Have each student examine the patient on their own and then describe out loud what they observed. Talk through the differential diagnosis for the examination finding. If possible, have learners examine patients with different examination findings of the same organ system (Example: systolic murmur versus diastolic murmur) to solidify the differences in findings.
Consider modeling your approach to the physical examination maneuver for the learner if it is their first time performing the maneuver with you. Utilize the teach back method. For material that was already covered, quizzing learners about different physical examination findings and maneuvers can help solidify knowledge.
Branch out beyond the patients on your team. Take your team to see other patients with interesting physical examination findings after obtaining the patient’s permission of course. Most patients love to be a part of the teaching experience (99% of patients in Dr. Mansoor’s experience).
Technology can be a valuable tool to help calibrate or hone physical examination skills once you know the patient’s diagnosis. For example, if a patient has mitral regurgitation on echocardiogram, you can evaluate the patient for a holosystolic murmur at the apex, listen to the axilla for radiation, and try the handgrip maneuver.
The physical examination is a powerful tool we can utilize to save patients time and money.
Physical examination findings serve as clues to help us efficiently arrive at the correct diagnosis.
Listeners will become familiar with ways to effectively teach physical examination.
After listening to this episode listeners will…
Dr Mansoor reports no relevant financial disclosures. The Curbsiders Teach report no relevant financial disclosures.
Mansoor A, Kryzhanovskaya E, Heublein M. “#13 Teaching the Physical Exam. The Curbsiders Teach Podcast. http://thecurbsiders.com/teach August 9, 2022.
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