Getting Started

Introduction

Many students find physical diagnosis skills difficult to perform when examining patients, and teachers find them difficult both to demonstrate and to interpret importance. Therefore, this website goes beyond the basic physical diagnosis skills taught in the first year of medical school. In addition, many time-honored traditional techniques now have been studied for their accuracy and reproducibility. With limited time for evaluation of patients, it is helpful to focus on those maneuvers that most accurately and efficiently lead to diagnosis.

For those desiring to read more about physical diagnosis skills, check out the General References.

Objectives:

Develop skills of trainees (students and residents) in advanced physical diagnosis techniques and their application to patient care.
Suggest approaches for faculty to teach physical diagnosis.
Demonstrate how to conduct attending rounds that include bedside teaching.
Use critically reviewed literature on rational clinical exam for the evaluation of patients.

Rationale:

Appropriate use of history and physical examination is essential to clinical practice. There is a renewed interest in physical examination skills and return to teaching rounds that include patients. There are many indications, however, that current medical students and medical residents are deficient in some aspects of physical diagnosis. For example, in site-specific studies and a national survey, the practice of cardiac auscultation, considered one of the keystones of physical examination, has been demonstrated to be lacking in medical residents.

Many faculty, trained in an era that de-emphasized bedside teaching, lack skills in physical diagnosis. In a study of faculty assessment, Noel, et al., demonstrated that attending physicians were often unable to detect both subtle and obvious mistakes made by students and residents in history and physical examinations. Many faculty also have not had role models for bedside teaching.

In addition to skills of history-taking and physical examination, one needs to consider medical literature evidence of accuracy in exam maneuvers, including sensitivity, specificity, and amount of contribution to patient diagnosis. For more information on critical analysis of literature, check out McMaster University's Evidence-based Medicine Informatics Project which includes The User's Guides for Medical Literature Series.

About the Website

Main Menu

The main menu on the Skill Modules page allows you to select any individual skill module: Heart Sounds & Murmurs, Liver & Ascites, Neck Veins, Pulmonary, and Thyroid. In addition, you can access this Introduction and the Epidemiology Glossary independent of the skill sets.

Skill Menu Categories

Each physical diagnosis skill module, for example, ascites or Neck Veins, will cover similar content.

Examination techniques: a description of "how to perform" with audio/video demonstrations.
Historical features: origins of maneuvers and interesting information on why maneuvers are performed in a certain way.
Pathophysiology: the underlying mechanisms that result in the physical finding and explain the disease process.
Associated evaluation: patient history, related physical exam, and laboratory/imaging data.
Differential diagnosis: possible etiologies to consider when the finding is present.
Evidence based: existing data on sensitivity, specificity, and inter-observer variability; with References and Epidemiology Glossary of Terms.
Teaching Tips: techniques for demonstration of the maneuver and audio/video resources of master clinician-teachers.

Each skill module is independent of the others. They can be viewed in any order desired.