We read with interest Block and Easton’s plea that we should claim the focused examination as a specialist GP skill that we can be proud of.1
GP teachers who provide clinical placements for Keele’s undergraduate medical students report informally that students sometimes question their practice of performing focused rather than full, systematic ‘PACES-style’ examinations, and as a consequence they lack confidence in teaching examination skills. Conversely, students often question the need to examine patients when so much imaging is available, and is requested, in hospitals.
We have begun to try to address these problems. We have developed a workshop entitled ‘Learning and Teaching the Skills of Evidence Based Physical Examination (EBPE)’ for clinical teachers. This provides participants the opportunity to consider the evidence for the use of focused examinations in their day-to-day work, as well as the practical aspects of teaching evidence- based physical examination.2 We have delivered this locally to our GP teachers and to a multidisciplinary audience at the 7th International Clinical Skills Conference in Prato, 2017. Informal feedback has suggested that the workshop has increased participants’ confidence in their examinations in their clinical practice, and in their teaching.
Alongside this, Keele’s Year 4 students have a 4-week general practice-based course on clinical reasoning that promotes focused examination to test diagnostic hypotheses, which they are taught to generate consciously during history taking.3,4 We hope that our graduates will build on this learning and become confident that their examinations accurately inform the decisions they need to make for individual patients in whatever clinical setting they are working in.
We believe that our work is helping to highlight this important area of practice, teaching, and learning to both students and their GP teachers, and wholeheartedly agree with Block and Easton that more work is needed if we are to understand how GPs use clinical examination in practice, and how it can be used even better.
REFERENCES
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