You will be assessed on your clinical skills with patients, mannequins, synthetic models, and other simulation devices.
Review videos (medical interviewing, communication, physical exam) used in Clinical Skills 2A & 2B (Physical Diagnosis). The videos can also be found in the "PSOM - Clinical Performance Experience (CPX)" Chalk site.
- Genito-Urinary (male and female genital)
- Mental Status Exam
- Mini-mental State Exam
Review core clinical skills learned in clerkships such as:
- Heart sounds
- Lung sounds
Complete selected readings:
On the physical exam:
Rapid Access Guide to the Physical Examination
Donald W. Novey (Year Book Medical Publishers, Inc., 1988)
For communication skills:
The Patient’s Story: The Integrated Patient Interview
Robert C. Smith (Little, Brown and Company, 1996)
For focused history and physical:
Textbook of Physical Diagnosis: History and Examination
Mark H. Swartz (W. B. Saunders Company, 1998)
Anticipate the Checklist (excerpted from “Mastering the OSCE,” Reteguiz, Cornel-Avenadano, McGraw-Hill, Inc., 1999):
Develop the following checklist items for each patient:
- History of present illness (pertinent +/-)
- Past medical history
- Family history/social history
- Physical examination (pertinent +/-)
- Communication skills
The history: ask yourself
- What organ system am I dealing with?
- What are the likely causes of the problem?
- What risk factors could have contributed to the problem?
- What complications of the problem exist in this patient?
For a systematic exploration of the patient's complaint of pain, ask:
- Onset and chronology
- Location and radiation
- Quality of pain
- Severity of pain (“On a scale of 1-10, with 10 being the most painful…”)
- Alleviating factors
- Precipitating factors
- Associated symptoms
Remember when doing the physical exam:
- Do not do a comprehensive Physical Exam.
- Do a focused Physical Exam based on the presenting problems. Once you choose to do an exam system (heart, for example), do that system thoroughly.
- Perform maneuvers using the proper technique learned in Clinical Skills 2.
- Some maneuvers may be painful to the patient. Get the data you need, but minimize the patient's discomfort.
- Show consideration for the patient’s modesty and discomfort, but expose areas for examination as appropiate.
- Never examine through the gown or drape: always skin-on-skin.
And practice with your peers!