How to improve physical exam skills?

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How can we improve our physical exam skills as a clinical med student? Most of the time, I'm too scared to interrupt someone's routine and be like "Can you teach me?" or ask the parents again "Can I listen again?" with the preceptor there or even after they're gone since their kid is usually in a lot of distress or uncomfortable and wouldn't like the exam repeated. During second year it was a lot better teaching since we had actual teaching sessions, and all the preceptors would let you listen etc. when there were interesting findings. But now, people are just too busy to confirm your physical findings, and when I'm wrong, I don't really get to listen/see again.

Should I just be more forward (but risk pissing people off or wasting their time) or is there some other way of improving my physical exam skills? I can try to perfect the techniques, but a lot of the time w/ lung or cardiac sounds, I have no idea what I'm really hearing.

 

[bawer234]

How can we improve our physical exam skills as a clinical med student? Most of the time, I'm too scared to interrupt someone's routine and be like "Can you teach me?" or ask the parents again "Can I listen again?" with the preceptor there or even after they're gone since their kid is usually in a lot of distress or uncomfortable and wouldn't like the exam repeated. During second year it was a lot better teaching since we had actual teaching sessions, and all the preceptors would let you listen etc. when there were interesting findings. But now, people are just too busy to confirm your physical findings, and when I'm wrong, I don't really get to listen/see again.

Should I just be more forward (but risk pissing people off or wasting their time) or is there some other way of improving my physical exam skills? I can try to perfect the techniques, but a lot of the time w/ lung or cardiac sounds, I have no idea what I'm really hearing.

Yep, its your job to make sure that your training is progressing the way it needs to be. Step up and tell the patient that you're going to listen again...don't ask. Obviously you should do this politely, but in my experience the more authority you show the better.
This is a pretty common problem that I've noticed in a lot of other medical students that I've rotated with so don't feel too bad.......BUT remember you're PAYING to be there and to learn, NOT to simply watch. I think a lot of students would be surprised at the amount of respect that your patients and attendings give you if just start seeking it out.

 

[McGillGrad]

If you are a 3rd year student (and I ask because it sounds like you are in the pre-clinical years), then simply say what bawer234 said above. I am going to take a quick listen to your ___________, is that okay? Almost everyone says 'ok'.

Think about it this way. The patient is getting more attention from the doctors. They wait a long time to see the doctors, so anything that extends that time is good for 95% of patients.

 

[IM Substance P]

How can we improve our physical exam skills as a clinical med student? Most of the time, I'm too scared to interrupt someone's routine and be like "Can you teach me?" or ask the parents again "Can I listen again?" with the preceptor there or even after they're gone since their kid is usually in a lot of distress or uncomfortable and wouldn't like the exam repeated. During second year it was a lot better teaching since we had actual teaching sessions, and all the preceptors would let you listen etc. when there were interesting findings. But now, people are just too busy to confirm your physical findings, and when I'm wrong, I don't really get to listen/see again.

Should I just be more forward (but risk pissing people off or wasting their time) or is there some other way of improving my physical exam skills? I can try to perfect the techniques, but a lot of the time w/ lung or cardiac sounds, I have no idea what I'm really hearing.

First of all, you need to push your teachers... truthfully. The reality is that even many of your best residents are simply not very good at the clinical exam. However, if you ask them lots of questions, you force them to be good.

Second of all, patients usually like it when you take more time to examine them. They feel like they're getting a better "check up" because they don't realize how worthless many clinical exam maneuvers are. Especially if they're in the hospital, they don't have much else to do anyways. Spending a few extra minutes to practice your exam skills on them can actually foster a bond between you and them.

I would warn patients though because they may not be used to having their heart auscultated for 30-60 seconds (even though we all should). Just say, "I'm going to take some time to get a better listen. Do you mind?"