The Teaching of Clinical Skills and the Applicability of a Simplified Guide for Physical Examination in the Undergraduate Medical Program

ABSTRACT

Introduction

In spite of technological advances, anamnesis and physical examination are still the most important and effective early diagnostic tools in any clinical case. However, many students graduate in medicine lacking these essential skills. The absence of a standardized physical examination is one of the main difficulties in the teaching-learning process.

Objective

To evaluate the clinical skills of medical intern students and the applicability of a simplified physical examination guide for improving these skills.

Methods

This was an analytical and quantitative-approach study, which compared before-and-after information among general medicine student interns from January to February 2014. The students were trained with the simplified guide for a 3-week period and their clinical examination was evaluated in 13 items: vital signs, examination of oral cavity, fundoscopy, otoscopy, thyroid examination, cardiovascular examination, pulmonary examination, abdominal exam, lymph nodes, anthropometric measurements, ankle-brachial index (ABI), neurological examination, examination of the breasts or testicles (examination of breasts for female patients and testicles for male patients). The result of the evaluation of each item was classified into 3 categories: complete evaluation, partial evaluation and no evaluation.

Results

A total of 31 students participated. Significant improvement was found in almost all items in relation to the complete evaluation after training with the guide: cardiovascular system (3.23% versus 74.19%, before and after training, respectively, p < 0.01), pulmonary system (22.58% versus 90.32%, p < 0.01), abdominal exam (22.58% versus 74.19%, p = 0.01), vital signs (16.13% versus 100%, p < 0.01), palpation of lymph nodes (6.45% versus 77.42%, p < 0.01), neurological examination (0% versus 22.58%, p = 0.02), thyroid palpation (0% versus 61.29%, p < 0.01), examination of oral cavity (6.45% versus 67.74%, p < 0.01), anthropometric measurements (0% versus 45.16%, p < 0.01), breast examination (0% versus 36.84%, p = 0.02), fundoscopy (0% versus 32.26%, p < 0.01), evaluation of the ankle-brachial index (0% versus 83.87%, p < 0.01), examination of the testicles (0% versus 8.33%, p = 1.0). An increase of 280.7% was also observed in the students’ median score after training (1.92 versus 7.31 points, P < 0.001). There was no significant correlation between student performance and time on the medical course (R2 = 0.1242; P = 0.0515).

Conclusions

There is a large deficit in teaching clinical skills during undergraduate medical courses. As an effective solution, a simplified sequential clinical examination guide can serve as training for medical students.

Physical Examination; Medical Education; Guide; Undergraduate Medical Education