This post will give you some useful tips for the clinical examination stations. Cheers!
Being clinicians, we all know the importance of history-taking that it is a way to know the details of presenting symptoms. Clinical or Physical Examination is the next essential step in the assessment of a presenting problem.
Through all these years in medical school and residency, these two tools are emphasized, yet these are ignored by most of us mostly due to the tiring rounds and busy schedules of the hospital. Exams are the stopovers where most of the students realize – ‘How important it is to master these skills. I wish I could have realized that before.’ Luckily, you are never too late to start over again after this realization.
Physical examination is an integral part of any postgraduate exam you take in clinical specialities. In Medicine, it is a feared area in exams because of the versatility of diseases, presentations and uncertainty about picking up the findings. Therefore when the exam arrives, many candidates tend to stress more on refining their Physical examination methods. But in postgraduate exams, there is more to it than showing just your examination skills to the examiners. Now you have to execute proper methods, pick up findings and interpret them.
“Once you have realised your weaknesses, It’s never too late to start all over again.”
Here you are with 11 pieces of advice that are general in nature and most of the candidates usually overlook during their exams preparation. Please take note of these, make a checklist for yourself which pertains to you and make it a point to improve during your practice for exams. The aim shall be to make these your habit, so you don’t have to think but rather do it – without being conscious of it anymore!
- Read Clinical Scenario Carefully. This may help you anticipate what you are going to find e.g., ‘Inspect the precordium and do cardiovascular examination’ may help you make the mind about finding surgery scar for valvular heart disease in a patient presented with palpitations. Moreover, just stick to what you have been asked in the scenario. Overdoing would just result in wasting your time and examiners will also not be impressed.
- Cheerfully Greet the Examiners. Do it in a nice & decent way. This definitely will have a good impact.
- Greet the patient and Introduce yourself. This is necessary for building a rapport with the patient right from the start, and he/she will be more cooperative with the examination.
- Explain to the patient about what you are going to do – in Precise and easy language.
- Sanitize your hands. Do not forget to sanitize your hands before and after each clinical examination encounter. These are usually available at the bedside of every patient you examine. This part is now routinely done globally – thanks to Covid! 🙂
- Expose sufficiently as appropriate for the examination, yet take care of patient’s modesty & expose genitalia only when examined.
- Ask about pain or discomfort. Before palpating any region, ask about pain/discomfort in the region. Reassure that you will be gentle during the examination & ask to let you know in case of examination cause any discomfort.
These shall not be mere words. Stay gentle so as to not cause pain and keep an eye on the patient’s face for discomfort during palpation. On the other hand, do not be too gentle that important findings are missed by very light palpation. - Maintain composure, look organized and professional. This is only possible when you have sufficiently practised and can focus on picking up clues and findings instead of thinking about the next step in clinical methods.
- Inform the patient about every subsequent step of examination on the go before doing it so the patient is not anxious & remain cooperative. Additionally, this helps you score better in the part of ethical skills i.e., maintaining patient welfare.
- Thank the patient at the end of the examination and cover him/her up before turning around towards the examiners.
- Narrate your findings in a well-organized way. You have worked so hard all these months in mastering clinical skills and you don’t want to ruin it by not being able to tell your findings in a nice & organized manner. A good narration helps examiners move on to the questions instead of wondering what you are trying to tell them.
Why miss this important aspect which is overlooked by the majority! So, make your own narration style that shall be simple, organized & precise. Start rehearsing, and practice it every day during your preparation so that on exam day you don’t leave this aspect to chance. After all, it’s your Showtime.
Keep it as a checklist to judge yourself on how many points you fulfil in addition to practising physical methods themselves.