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      A new method for teaching physical examination to junior medical students

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          Abstract

          Introduction

          Teaching effective physical examination is a key component in the education of medical students. Preclinical medical students often have insufficient clinical knowledge to apply to physical examination recall, which may hinder their learning when taught through certain understanding-based models. This pilot project aimed to develop a method to teach physical examination to preclinical medical students using “core clinical cases”, overcoming the need for “rote” learning.

          Methods

          This project was developed utilizing three cycles of planning, action, and reflection. Thematic analysis of feedback was used to improve this model, and ensure it met student expectations.

          Results and discussion

          A model core clinical case developed in this project is described, with gout as the basis for a “foot and ankle” examination. Key limitations and difficulties encountered on implementation of this pilot are discussed for future users, including the difficulty encountered in “content overload”.

          Conclusion

          This approach aims to teach junior medical students physical examination through understanding, using a simulated patient environment. Robust research is now required to demonstrate efficacy and repeatability in the physical examination of other systems.

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          Most cited references 41

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          Adult learning theories: implications for learning and teaching in medical education: AMEE Guide No. 83.

          There are many theories that explain how adults learn and each has its own merits. This Guide explains and explores the more commonly used ones and how they can be used to enhance student and faculty learning. The Guide presents a model that combines many of the theories into a flow diagram which can be followed by anyone planning learning. The schema can be used at curriculum planning level, or at the level of individual learning. At each stage of the model, the Guide identifies the responsibilities of both learner and educator. The role of the institution is to ensure that the time and resources are available to allow effective learning to happen. The Guide is designed for those new to education, in the hope that it can unravel the difficulties in understanding and applying the common learning theories, whilst also creating opportunities for debate as to the best way they should be used.
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            Musculoskeletal medicine: an assessment of the attitudes and knowledge of medical students at Harvard Medical School.

            To assess medical students' knowledge and clinical confidence in musculoskeletal medicine as well as their attitudes toward the education they receive in this specialty. A cross-sectional survey of students in all four years of Harvard Medical School was conducted during the 2005-2006 academic year. Participants were asked to fill out a 30-question survey and a nationally validated basic competency exam in musculoskeletal medicine. The response rate was 74% (449/608). Medical students rated musculoskeletal education to be of major importance (3.8/5) but rated the amount of curriculum time spent on musculoskeletal medicine as poor (2.1/5). Third-year students felt a low to adequate level of confidence in performing a musculoskeletal physical examination (2.7/5) and failed to demonstrate cognitive mastery in musculoskeletal medicine (passing rate on competency exam: 7%), whereas fourth-year students reported a similar level of confidence (2.7/5) and exhibited a higher passing rate (26%). Increasing exposure to the subject by taking clinical electives resulted in greater clinical confidence and enhanced performance on the exam (P < .001). Students' feedback suggested that musculoskeletal education can be better integrated into the preclinical curriculum, more time should be spent in the field, and more focus should be placed on common clinical conditions. These findings, which are consistent with those from other schools, suggest that medical students do not feel adequately prepared in musculoskeletal medicine and lack both clinical confidence and cognitive mastery in the field. Implementing a four-year integrated musculoskeletal curriculum is one way that medical schools can address this concern.
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              Peer-assisted learning in teaching clinical examination to junior medical students.

              In medical education, peer-assisted learning (PAL) refers to teaching occurring between fellow students. Few descriptions of its use to teach clinical examination have been published. Student Grand Rounds (SGR) is a student-led initiative whereby senior students volunteer to teach clinical examination to pre-clinical peers. Student tutors attend a modified Teaching on the Run (TOTR) course originally designed to train clinicians to teach students and junior doctors. We investigated the value of SGR in teaching pre-clinical students, and evaluated the effectiveness of TOTR. Over 9 months, tutors and participants in each SGR tutorial completed an online survey. At the conclusion of annual TOTR workshops (2004-2010), participants evaluated their impressions of the course. A total of 64 SGR tutorials were attended by a total of 321 students. All agreed that tutorials were beneficial and enjoyable, with a threefold increase in the number of students self-identifying as able to perform the skills required. TOTR participants classified the course as both relevant and beneficial, and all course outcomes were achieved. SGR tutors reported improved knowledge and confidence in teaching following SGR and TOTR. PAL is effective in supplementing teaching of clinical examination. Senior students learn valuable skills and gain experience in teaching.
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                Author and article information

                Journal
                Adv Med Educ Pract
                Adv Med Educ Pract
                Advances in Medical Education and Practice
                Advances in Medical Education and Practice
                Dove Medical Press
                1179-7258
                2016
                18 February 2016
                : 7
                : 91-97
                Affiliations
                Peninsula College of Medicine and Dentistry, Plymouth, UK
                Author notes
                Correspondence: Meelad Sayma; Hywel Rhys Williams, Peninsula College of Medicine and Dentistry, John Bull Building, Tamar Science Park, Plymouth PL6 8BU, UK, Email meelad.sayma@ 123456students.pcmd.ac.uk ; Hywel.williams@ 123456students.pcmd.ac.uk
                Article
                amep-7-091
                10.2147/AMEP.S100509
                4762462
                26937208
                © 2016 Sayma and Williams. This work is published and licensed by Dove Medical Press Limited

                The full terms of this license are available at https://www.dovepress.com/terms.php and incorporate the Creative Commons Attribution – Non Commercial (unported, v3.0) License ( http://creativecommons.org/licenses/by-nc/3.0/). By accessing the work you hereby accept the Terms. Non-commercial uses of the work are permitted without any further permission from Dove Medical Press Limited, provided the work is properly attributed.

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