Clinical examinations: a medical student’s perspective
Arjun Menon, Rahul Menon, Vishnou Mourougavelou
Faculty of Medicine, Imperial College London, London, UK
We read with great interest the research by Shields et al,1 evaluating the most effective ways of teaching the clinical abdominal examination to medical students. As medical students ourselves, we too have noticed how variability in cohort size, teaching style, and levels of practice can affect competency when performing a clinical examination.
At Imperial College, London, students are taught to perform examinations on real and simulated patients from an early stage. It is natural that students would like to examine real patients with clinical signs as without this experience early on in their medical career, it would put them at a disadvantage when they are required to recognize pathology. A randomized experiment found that what students valued most was the “authenticity” of real patient encounters.2 We do however acknowledge that simulated patients have their benefits, especially during the early learning stage. Furthermore, finding real patients who are willing to volunteer their time for the teaching of medical students can be challenging.1
Another important factor to the successful teaching of the clinical examination is the size of the group. In a study of 48 medical students studying the musculoskeletal examination, it was found that through small-group interactive examination skills teaching, the students improved their skills immediately after the teaching but also maintained these acquired skills several months on.3 The controls on the other hand, who only carried out regular clerkship activities, such as hospital placements, were unable to improve their examination skills.3
Helen M Shields,1 Nielsen Q Fernandez-Becker,2 Sarah N Flier,2 Byron P Vaughn,2 Melissa H Tukey,2 Stephen R Pelletier,3 Douglas A Horst2
1Department of Medicine, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA, 2Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA, 3Center for Evaluation, Harvard Medical School, Boston, MA, USA
We are happy to respond to the excellent comments in the Letter to the Editor by Arjun Menon, Rahul Menon, and Vishnou Mourougavelou, medical students at Imperial College, London, regarding our recently published article entitled “Volunteer Patients and Small Groups Contribute to Abdominal Examination’s Success”.1
We completely agree with Imperial College London’s routine practice of using “real patients” from the beginning of medical school for students to practice their physical examination skills. We would like to clarify and confirm that it is also our practice to use “real patients” for our Abdominal Examination Exercise. Our ability to recruit sufficient “real” volunteer patients each year for 43–46 small groups for the Abdominal Examination is the result of the popularity of this exercise with these patients.1 We have not had the difficulty in recruiting patients as noted by Bokken et al2 perhaps because all the patients came from the practices of the two Directors of the Abdominal Examination (HS and DH) who were committed to utilizing “real” patients.
View the original article by Shields et al
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