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General approaches to clinical examinations

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General approaches to clinical examinations

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In general:

Inspection (environmental, general, regional)

Palpation

Percussion

Auscultation

MSK exam:

Look

Feel

Move

An example checklist made by integrating university teaching materials and other learning resources (importance of active learning, making associations to pre-existing knowledge from other disciplines e.g. anatomy and developing clinical reasoning)

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MJ THREADS Ca for important conditions:

Myocardiac infarction

Jaundice

Tuberculosis

Hypertension

Rheumatic fever

Epilepsy

Asthma

Diabetes

Stroke

Cancer (and treatment if so)

BOXES for considering investigations:

Bloods

Orifices

X-rays

ECG

Special tests

DRUGS for medical history taking

Doctor (prescribed)

Recreational (Alcohol, Smoking, illicit drugs)

User (OTC/Pharmacy medicines including creams/lotion/gels, inhalers, sprays, patches, drops, suppositories/pessaries, herbal remedies)

Gynaecological (contraceptives / HRT)

Sensitivities

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Perhaps include a detailed ABCDE assessment in the form of a case study - could start from a patient arriving 'unwell' and a paramedic giving an SBAR handover. Followed by a detailed structure for an A-E. This comes up in every single OSCE!

We could explain this A-E using a high fidelity simulation - and emphasise that simulations are LOW RISK so great learning tools

Talk not only about how to receive feedback but also how to critically appraise others performances as this will help with your own learning too

We could also give an example for communication skills - SOCRATES is usually a good place to start and is relevant for most health professionals

We could create a table for SOCRATES and write some examples for how to phrase each question

We could discuss how to give an appropriate SBAR - this is relevant to nurses, paramedics, doctors, PAs etc....

Discuss challenges faced by students - imposter syndrome, difficult patients, lack of confidence, forgetting what to do next in an OSCE/observed setting

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The thought of starting clinical placements is both exciting an terrifying all at once. It might be nice to talk a bit about what to expect (both good, and not so good). Feeling prepared can take the fear away.

-it might be nice to follow a group of students during this section who all encounter different challenges (intense supervisors, lack of confidence, independent learning etc.)

Could include a top tips section (or survival guide) - how to impress/ how to get the most out of a placement

How to approach challenges on placement - i.e. being interrogated on ward rounds.

Communicate with other members of the team - learn about their roles - their experience can also be useful to you

Know who to contact if you need support - some days can be stressful

Clinical examinations/patient interactions

Be prepared - the OSCE techniques learned already are useful here - know the basics

Have a structure (ABCDE, SOCRATES, WIPER) - real patients can often divert the conversation away from relevant topics

Real patients can often present differently to simulated ones - it is ok if it takes more time in this setting

Be keen - examining/talking to patients (if appropriate) is the best way to gain confidence in your ability

Be observed - this can be scary, but the feedback from this will be valuable

Work as a team - gain the confidence as a part of a team, until you are ready to try alone

The patient will not know if you have made a mistake during your examination - so do not feel embarrassed by this - confidently correct the error

How to make the most out of a busy placement

Sometimes a supervisor simply does not have time to teach you or supervise your placement day, it is important to have a plan in place if this happens

Establish what tasks you can perform independently (history/exams)

Inform someone about what you will be doing before hand

Speak to as many patients as possible

Find a patient and learn everything about their case - use their records too

Shadow a member of staff - does not have to be someone from your profession

Achieve what you can - and then it is OK to consider doing independent learning/study time

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As a current student studying for OSCEs I would be looking for this information from this chapter...

Preparing for an OSCE

Identify a partner/group that you feel you can work well with - have similar goals

Practice early and regularly - do not focus solely on examinations - communication skills are key!

Make your own checklists (using appropriate teaching and trusted sources) - your checklist will be different from other peoples. - follow the same style for each possible OSCE scenario - the repetition makes it easier to remember in exams

Practice with family or friends that have little to no medical knowledge - this will ensure that you can correctly explain and understand

Learn when out on placement - practice on people with real life pathology and signs - this helps to understand WHY examination signs are relevant and can help with differentials in an OSCE

How to approach any physical examination

WIPER

Look, Feel, Move, Listen (+special tests)

IPPA - Inspection, palpation, purcussion, auscultation

Quick, and easy to remember acronyms that can help in any clinical examination - especially in high stress situations such as exams

How to approach any communication station

ICE-BAR - Introduce yourself and gather patient identity, Check concern/agenda, Explore ideas, concerns, expectations, Be clear and empathetic, Address the problem, Recap, reassure, and safety net

How to interpret and approach constructive feedback

Consideration that first time feedback can be difficult for any student - and to not take this as a personal attack - it is an opportunity!

You can let your tutor know in the next session that you are working on (X...) and ask them to give you specific feedback on this to monitor improvement

SMART action plans - this is a useful tool for breaking down each point and being productive to make changes

Try new things - different methods work better for different people. Give it a go and see in real time if it works for you

How to effectively manage time in an OSCE

Break each station into 3 parts - introduction and explanations (2-3mins), main task (3-6mins), summarise, safety net, and questions (2mins)

Practice these OSCE scenarios in real time with a partner - do not skip or rush over points during practice. This will allow you to get realistic timings

Prioritise - if time is short, know what the station was asking from you so you can choose which parts are more important

Listen for the timers - with 2 minutes remaining start thinking about closing the OSCE

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The "What if!" perspective...

What if you were a student in your first clinical year e.g. year3, what content in this chapter would attract you to reading it happily and thoroughly?

What if you were a student preparing for an upcoming high fidelity simulation session on trauma management, what content in this chapter will make you want to read it thoroughly?

What if you were a student preparing for an OSCE, what content, tips, advice in this chapter would you be looking for?

What if you were a student who received your first OSCE feedback in writing (example,1,2,3), how will you deal with such feedback?

What if you were asked to write a reflective piece for your portfolio, how will you do that?

What if you were asked to be prepared to demonstrate a physical examination in a clinial round in front some of your classmates and other doctors in training, how would you prepare for that and what will you do on the day?

What if you were assigned to a clinic with a very busy clinician who barely finds time to greet you when you arrive or leave, how will you ensure to maximise your learning experience during such placement?

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to cosider having a section about Role of AI in clinical learning 

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to cosider having a section about Role of AI in clinical learning 

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What do we mean when we say AI? types, forms, etc

How can AI help me learn better? discuss approaches, principles of use, and examples of platforms currently used by medical and health professions students globally e.g. GIZMO, etc

Can AI help improve or support my patient care?

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briefly define what reflection means, show why is it important and its role in delibrate practice and professional growth, then show how to reflect by sharing tools of reflections.

e.g.

John Driscoll's reflective framework

What? Describe the experience, including the facts and feelings (description)

So what? Analyse the experience and make sense of what it means (analysis of significance)

Now what? Use the learning from the previous stages to create an action plan for the future (action plan to inform future practice)

5Fs: Facts, Feelings, Findings, Future

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Thoughts hunting ... suggesting scope of coverage

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Thoughts hunting ... suggesting scope of coverage

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thoughts on content coverage in this chapter...

A preamble about learning in health professions, introducing the concept of authentic learning and how to optimise one's learning experience (Ayad)

Introduce simulation as means for authentic learning

Define what "simulation-based learning" means

Forms of simulation in health professions education: part-task, whole-task, low, medium and high fidelity, patients (virtual, simulated, standardised, or volunteer)

How to optimise learning through simulation

Overview on assessment of learning following simulation or clinical learning

What is OSCE?

How does simulation-based learning prepare students to OSCE

Strategies for effectively preparing for OSCE, time management, structured clinical examination, and reflection or feedback,

How to develop confidence in clinical abilities and improve performance in simulated contexts

How does simulation-based learning prepare students to real-world practice

How to develop confidence in clinical abilities and improve performance in patient-care environments (survival tips for clinical placement)

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to use series of scenarios as triggers to introduce situations for learning (i.e. scenario-based learning) i.e.

Scenario proposed a "Situation", "What to do?", "How to do it?" and resources to learn more.

e.g. Sarah, Tanya, Adam, and Rajesh (known among their batch as the STAR group) are assigned as one group to the same primary care (PC) placement in their second year of the medical school. Their first week at the PC was very exciting as their supervising doctor asked them to meet a 58-year old patient who attended the clinic for a routine annual health check. They felt that they could apply what they learnt in the clinical skills sessions at school when doing a throrough physical examination. Sarah suggested they take ten minutes before they meet the patient to go through what they would like to do. The first thing that came to their minds was the WIPE acronym which includes Wash your hands, Introduce yourself & ask about patient’s name & identity, Procedure explanation, Permission to examine the patient. Privacy, Position the patient appropriately, Pain: enquire if the patient is in pain, Exposure to be limited to the part being examined as you proceed, Equipment-check. They then reminded each other of the need to start with a general inspection, then doing the examination by starting with the hands and arms, moving to the head and neck down to the chest and abdomen then down to the lower limbs whilst doing inspection, palpation, percussion and auscultation as they moved to a different part of the body as relevant. (see figure ? checklist for this exam)

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General ideas for a writing approach

1.Using a case/vignette introduce the reader to "WHAT to do" and "HOW to do" it when performing a clinical skill e.g. You're sent to see a newly admitted 35 years old patient who presented with cough and shortness of breath for 7 days. What will you do and how? i.e. history and physical exam

2.using acronyms to remember what and how to do things e.g. WIPE. Similarly acronyms that can help learn, present, or gain more from being around doctors who have limited time e.g. SNAPPS, RIME, etc