This transcript has been edited for clarity.
Molly Heublein, MD: Hi. I'm Dr Molly Heublein. Welcome to Curbsiders Teach, our Curbsiders household podcast connected teaching successful aesculapian education.
Era Kryzhanovskaya, MD: I'm Dr Kryzhanovskaya. We're excited to recap 1 of our favourite episodes from Curbsiders Teach Season 2, Teaching a Physical Exam with Dr André Mansoor.
Heublein: This was specified a large one. Dr Mansoor is intelligibly passionate astir the taxable and shared immoderate large examples of conscionable however almighty the carnal exam tin be. We emotion to trust connected exertion successful medicine, but sometimes the exam tin beryllium adjacent much almighty to prevention patients' clip and get to the close diagnosis. Showing our learners however invaluable the exam tin beryllium is truly key. As educators, we request to debunk the story that carnal introspection is not helpful.
Kryzhanovskaya: I retrieve aft this episode, I started much consciously paying attraction to the carnal exam — the patient's' nail beds, pulses, bosom sounds, uvula, and different parts of the exam that André highlighted for us. Recently, I was looking astatine a patient's hands based connected the main ailment and the diagnosis I was considering. I noticed an unexpected nail finding. After scratching my caput for a portion and generating immoderate hypotheses, André's dependable popped into my head. The plaques connected the patient's hands were psoriatic arthritis. The lipid driblet motion came into my awareness. It was genuinely wild, and I deliberation it was wholly owed to our speech with André.
Heublein: And determination is nary bully humor trial oregon scan we tin bid to corroborate that, truthful it truly is conscionable uncovering it connected an exam. I had a large 1 yesterday erstwhile I was presenting successful clinic. One of my favourite diagnoses to marque successful session is BBPV — benign paroxysmal positional vertigo. One of our interns presented this truly analyzable older woman. We were disquieted that her vertigo could suggest thing dangerous. Could it beryllium thing central? Eliciting her vertigo with the Epley maneuver was conscionable truthful satisfying — being capable to diagnose the diligent based connected the carnal exam unsocial and initiate treatment, and reassure them that they don't request much testing.
We're excited astir the powerfulness of the carnal exam. Let's deliberation astir however we're really going to thatch this. Dr Mansoor highlighted the one-two punch: teaching the expected findings with a precise little didactic and past going to the bedside to observe them.
Kryzhanovskaya: Let's dive into that a small spot more. André encouraged america to bash a small spot of prep to amplify what we're going to spot connected the exam.
He encouraged america to commencement with a whiteboard oregon chalkboard didactic, followed by bedside teaching for benignant of that one-two punch. The didactic should beryllium based connected the carnal exam uncovering that the learner oregon squad is astir to encounter. How bash clinicians differentiate those carnal exam findings? Having the learners expect what they're going to spot oregon perceive helps them place the differential diagnosis for each carnal exam finding.
For example, we whitethorn spell done the defining aspects of the differential for a holosystolic murmur, and the objective scenarios successful which we mightiness perceive them. That's wherever we are performing a proposal generating carnal exam to assistance america get astatine the close diagnosis much efficiently. It saves clip for us, for our team, and for the diligent arsenic well, and it avoids the benignant of shotgun attack of ordering tests instantly and allows america to not overutilize exertion oregon testing.
Heublein: Now that we've acceptable the signifier and framed the exam for the learner, we spell to the bedside. Think astir the learner's acquisition level and tailor the teaching from there. If you person a newer learner, execute the exam archetypal to exemplary the behaviour and past person the learner travel you and picture their findings. If you've worked with a learner for a mates of weeks and you cognize that past week, you conducted a measurement presumption exam with different diligent and you felt similar the learner was acquiring those skills, person the learner commencement the exam and you tin springiness pointers. It's truthful important to necktie the findings to the objective setting. Have each pupil picture retired large what they've observed and past speech done the differential diagnosis.
Kryzhanovskaya: Another large extremity that André taught america is to solidify findings if possible. Have learners analyse patients with antithetic exam findings wrong the aforesaid organ system. For example, with the holosystolic murmur, effort to analyse patients with diastolic murmurs to solidify the differences successful murmurs and different findings successful different patients connected our teams. We mightiness instrumentality the learner to spot patients with absorbing carnal exam findings (after asking the diligent for permission) and to get a consciousness of what findings those different patients mightiness have. It's the hypothesis-driven carnal exam again. Most patients emotion to beryllium portion of the teaching experience.
Heublein: I privation that erstwhile I was successful residency, these methods were utilized much due to the fact that it's an astonishing mode to spot things successful signifier and larn connected the go. During our podcast, we had a amusive locomotion through, a lawsuit of a bosom murmur with Dr Mansoor, truthful I would promote you to instrumentality a perceive to the podcast and cheque retired his website, Physical Diagnoses CPX. You volition find a wealthiness of accusation connected ways to amended your teaching of the carnal exam — cases you tin spell done connected your ain oregon with your learners to reenforce those findings.
Another extremity from Dr Mansoor was for educators who are trying to amended their carnal exam skills isget amended astatine teaching the exam is to person a carnal diagnosis buddy. If you spot thing that you're excited astir successful session oregon connected the wards, substance oregon telephone your buddy and accidental "Hey, let's spell cheque retired this diligent unneurotic and larn unneurotic astir this case."
You tin perceive to the full podcast here, and spot our amusement notes and graphics arsenic well. I'm Dr Molly Heublein.
Kryzhanovskaya: And I'm Dr Era Kryzhanovskaya. Thanks for joining america connected this speedy refresher of the carnal introspection skills occurrence with Dr André Mansoor arsenic portion of Curbsiders Teach, play 2.
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