Integrating the Physical Exam into Teaching

William B. Jordan MD, MPH
Arati S. Karnik MD
Sharyn H. Miskovitz MD
Jennifer M. Purcell PhD
Sandra F. Braganza MD, MPH
Subha Ramani MBBS, MPH, MMEd
Ellen P. Tattelman MD
Attachments: Size & Download Count
Wordscript-inpatient.doc 34 KB   (833)
Wordscript-outpatient.doc 31.5 KB   (804)
Wordevaluation-card.doc 54.5 KB   (375)
WordPhysical-Exam-Teaching-Tips.doc 51.5 KB   (471)
Website Link (URL) p/u N/A   (332)
Power PointPhysical-Exam-RAT-FMDRL1.ppt 789.5 KB   (1509)
Resource Type:
   Peer Reviewed Resource (Reviewed, Approved)
STFM Group:
   Residency Education
Created (Modified):
   04/19/2011 (04/25/2011)
   View License Restrictions
Description of Resource
  This presentation is part of a quarterly Resident as Teacher series created to develop the teaching skills of residents. This one-hour session focuses on teaching the physical exam in a clinical setting. The session examines reasons for and challenges to teaching the physical exam with the patient present. Discussions of learner experiences and of video examples make the session interactive. Materials provided include a PowerPoint with facilitator notes, video links, and an assessment form. The content was based primarily on materials from the Stanford Faculty Development course (Skeff) and from a 12-step model of teaching at the bedside (Ramani). While intended for residents, this session may readily be adapted to use with faculty and community preceptors.
Learner Type
  - Resident
  - Fellow/Graduate Student
  - Faculty
  - Preceptor
Type of Material
  - Computer and Multimedia
  Computer and Multimedia
    - Video
  - Evaluation Materials
  - Presentation Handout
  - PowerPoint Lecture
  - Education Subjects
    - Assessment of Learner Performance
    - Clinical Education Methods
  - Faculty Development
  Faculty Development Topics
    - Clinical Teaching
  - Types of Learning or Learning Methods
  Types of learning
    - Lecture
Objectives (suggested 3-7)
  1) Identify challenges to incorporating the physical exam while teaching in the clinical environment 2) Discuss factors contributing to positive and effective physical exam teaching experiences 3) Evaluate scenarios where the physical exam is used as a teaching point
Has this been formally reviewed elsewhere?
  - No
Describe the effectiveness (if available) and significance of your work
  Ramani has developed and disseminated a model for teaching at the bedside. Her work has primarily been targeted towards training practicing physicians who are teaching residents and students. This module extends that work to the training of residents who are teaching junior residents and medical students. This module also adds an outpatient perspective to the traditional bedside teaching that takes place in the hospital, and includes both adult and child patients. It incorporates some of the lessons of the Stanford Faculty Development series (Skeff) and adds practical video demonstrations of the teaching techniques described. The written qualitative feedback from residents indicated that they learned the importance of preparing and planning, discussing with the patient beforehand, negotiating an agenda with the learner, assessing the learner, modeling the physical exam, debriefing, and offering feedback. The residents were happy to have a web resource for reviewing specific physical exam skills, including the evidence behind particular maneuvers.
Describe any lessons learned
  The videos were time-consuming to produce even though they were not professional in quality. However, audience feedback was overwhelmingly positive and suggested that it was well worth the effort. The residents would like to see more faculty development around these skills, and more role-modeling. The residents initially focused on individual physical exam maneuvers they would like to learn, but by the end of the session seemed to have absorbed the other issues at play in teaching the physical exam in a clinical setting.
Other Relevant STFM Groups
  - Faculty Development
  - Physician-Patient Interaction