What clinical skills training did you get in your M2 year?

[cbrons]

Very specifically asking what your school did to teach you various physical exam skills during your M1/M2 year. Did they just pair you up with classmates and give you a checklist of things to figure out on your own with minimal/no supervision from a faculty member? Did they give you a lot of one on one time to help you learn physical exam skills? Etc.

I'm just curious.

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[SouthernSurgeon]

Very specifically asking what your school did to teach you various physical exam skills during your M2 year. Did they just pair you up with classmates and give you a checklist of things to figure out on your own with minimal/no supervision from a faculty member? Did they give you a lot of one on one time to help you learn physical exam skills? Etc.

I'm just curious.

Our physical diagnosis course:

Part a) Lecture based class where we had a sub specialist come in and give overview of exam elements and findings for each body system (e.g. pulmonologist for lung, vascular surgeon for pulse exams), followed by breaking into groups for practice on each other with feedback from residents & faculty in same division. Special days for more advanced stuff like eye exams where we went to the ophtho clinics.

Part b) Weekly small group (3-4 students) with a faculty preceptor who would take us to the hospital for supervised, real exams on real patients with real pathology. Would have to then practice presenting like you would as an M3 to the attending preceptor, and write full H&Ps which were graded and we were given feedback on.


edit: We also had OSCEs with SPs, but ostensibly those were supposed to be more comprehensive and focused on the communications aspects rather than learning the actual exam. The only time we really had SPs for dedicated physical exam purposes were for the breast/pelvic exam sessions.

 

[DermViser]

Our physical diagnosis course:

Part a) Lecture based class where we had a sub specialist come in and give overview of exam elements and findings for each body system (e.g. pulmonologist for lung, vascular surgeon for pulse exams), followed by breaking into groups for practice on each other with feedback from residents & faculty in same division. Special days for more advanced stuff like eye exams where we went to the ophtho clinics.

Part b) Weekly small group (3-4 students) with a faculty preceptor who would take us to the hospital for supervised, real exams on real patients with real pathology. Would have to then practice presenting like you would as an M3 to the attending preceptor, and write full H&Ps which were graded and we were given feedback on.


edit: We also had OSCEs with SPs, but ostensibly those were supposed to be more comprehensive and focused on the communications aspects rather than learning the actual exam. The only time we really had SPs for dedicated physical exam purposes were for the breast/pelvic exam sessions.

Now that's how Physical Diagnosis courses should be done, esp. Part b).

 

[Frazier]

First half of ms1 is physical exam on other students.

Second half MS1 we are put in teams and individually assigned an inpatient to do h&p from scratch and orally present to attending then do a note/plan and get feedback.

First half MS2 we continue doing the inpatient stuff and also do outpatient settings at community PCPs and specialists.

Second half MS2 is a clinical procedures course.

Mix in OSCE days throughout both years.

Just did my first solo "medical procedure" (outside of ophtho dilations/glaucoma testing/etc) at a peds clinic... Cryotherapy on a wart 🙂

 

[sinombre]

MS1 we learned physical exams on standardized patients, for 4 hours every week or every other week. MS2 is similar, but we're expected to come up with differentials and treatment plans. We had an OSCE with every final first year, with a larger 5 patient OSCE at the end of first year. For MS2 we also have an OSCE with each final. We also have to go to an outpatient clinic for 5 hours every other week for all of first and second year, which helps so we're not only exposed to the healthy/normal standardized patients. We also have a doctoring class for 4 hours every other week for the first 2 years, which is basically interviewing standardized patients.

 

[Jabbed]

Our physical diagnosis course:

Part a) Lecture based class where we had a sub specialist come in and give overview of exam elements and findings for each body system (e.g. pulmonologist for lung, vascular surgeon for pulse exams), followed by breaking into groups for practice on each other with feedback from residents & faculty in same division. Special days for more advanced stuff like eye exams where we went to the ophtho clinics.

Part b) Weekly small group (3-4 students) with a faculty preceptor who would take us to the hospital for supervised, real exams on real patients with real pathology. Would have to then practice presenting like you would as an M3 to the attending preceptor, and write full H&Ps which were graded and we were given feedback on.


edit: We also had OSCEs with SPs, but ostensibly those were supposed to be more comprehensive and focused on the communications aspects rather than learning the actual exam. The only time we really had SPs for dedicated physical exam purposes were for the breast/pelvic exam sessions.

God that's a solid program. Where do you go if you don't mind my asking.

*Betting on Baylor*

 

[SouthernSurgeon]

God that's a solid program. Where do you go if you don't mind my asking.

*Betting on Baylor*

(a) My school changed curriculums since I took that course...don't have a clue what they do now as I've been out for a while

(b) Not Baylor

(c) Not telling, sorry

 

[Meh.meh]

Very specifically asking what your school did to teach you various physical exam skills during your M2 year. Did they just pair you up with classmates and give you a checklist of things to figure out on your own with minimal/no supervision from a faculty member? Did they give you a lot of one on one time to help you learn physical exam skills? Etc.

I'm just curious.

Going to edit certain aspects of the curriculum in order to preserve some anonymity.

Ours consists of:
1. 4-6 hours weekly class starting first week. Began on history, immediately moved to lower back/pain. Learned broad system based exams after. Practiced on a combination of one another, and standardized patients.

2. Weekly clinic time starting early M1 year, returning to same clinic weekly. Continue practicing H and P there, along with presenting and writing notes. Experiences/value of experiences varied greatly depending on location and preceptor.

3. This is yet to come, but sensitive exams are practiced near the end of M2 on standardized patients

4. Skills from above are tested in a number of OSCEs.

And I still feel clueless/helpless. I'm sure time and practice will help. :/

Edit: If there is any real weakness to our program, it's a tendency to learn something once and never speak of it again. Depending on your clinic, you may or may not get the opportunity to practice any given exam.

 

[Kaustikos]

I'm a different breed but I still followed the "curriculum". We had a preceptor that we met with once a week and also classes. We also had mini-evals on our physical examination three times a semester.
The preceptor was hit or miss because some gave no ****s. Others treated you like an intern. Nonetheless, I was doing this a lot second year.
The hours with preceptors also varied. Some had you doing 6 hours a day while others were just two hours.
In the end, I got a crash course on what I was doing wrong and things to improve. But it still didn't really teach me the important thing: what's important. I've learned there are portions of the exam you need to be adapt at doing fast and others you focus on.
Also, it's easy to do a physical exam. It's a pain in the ass to do it right or know what's "normal".

 

[Kaustikos]

Our physical diagnosis course:

Part a) Lecture based class where we had a sub specialist come in and give overview of exam elements and findings for each body system (e.g. pulmonologist for lung, vascular surgeon for pulse exams), followed by breaking into groups for practice on each other with feedback from residents & faculty in same division. Special days for more advanced stuff like eye exams where we went to the ophtho clinics.

Part b) Weekly small group (3-4 students) with a faculty preceptor who would take us to the hospital for supervised, real exams on real patients with real pathology. Would have to then practice presenting like you would as an M3 to the attending preceptor, and write full H&Ps which were graded and we were given feedback on.


edit: We also had OSCEs with SPs, but ostensibly those were supposed to be more comprehensive and focused on the communications aspects rather than learning the actual exam. The only time we really had SPs for dedicated physical exam purposes were for the breast/pelvic exam sessions.

Also add all of that. I forgot about all this stuff lol

 

[cbrons]

Goood.. anyone else? I need more details. I've volunteered my time for a committee to help improve the second year clinical skills curriculum at my school so I want to get a sampling of what its like at other schools.

 

[VisionaryTics]

Goood.. anyone else? I need more details. I've volunteered my time for a committee to help improve the second year clinical skills curriculum at my school so I want to get a sampling of what its like at other schools.

Physical exam skills taught in conjunction with basic science blocks in M1 (i.e. heart and lung exam during thoracic unit of anatomy, MSK during limbs, etc). The basic exam is taught on standardized patients with faculty instructors. The focused exams (head and neck, heart exam, lung exam) is taught by faculty of that specialty with workshops staffed by residents. About 50% of the time, patients/volunteers with real pathology are used. The focus during M1 is the basic exam; the focus during M2 is the focused exam and detecting pathology.

During M1 year, you are assigned to an outpatient general medicine clinic. You usually do two half days a month with your preceptor where you practice physical exam and interview skills. Three times throughout M2 year (between blocks), the M2s are assigned to general medicine teams. The M2s have a required number of observed H&Ps they have to perform (obviously on real patients who are admitted) as well as written H&Ps, progress notes, and oral presentations of both H&Ps and daily presentations. M2s are usually present for rounds, and there are weekly "physical exam rounds" where a senior faculty member will take all the M2s at a particular hospital on rounds with selected patients with interesting physical exam findings.

 

[togaedere]

Our physical diagnosis course during M2 is structured where we are paired in groups of two and examine standardized patients according to a prescribed organ-system exam skills sheet we are supposed to read ahead of time and follow along with. The standardized patient gives us feedback on proper technique as well as communication skills and whatnot and "grades" us based on how prepared we are (we don't get a final grade for the class outside of our OSCE exam but attendance is measured). As the non-examining part of the pair, the partner also is free to provide feedback and do some prompting if the examining person gets stuck along the way. Physicians rotate throughout the rooms and pop their heads in to see if anyone has any questions or is stuck on something, but honestly the standardized patients are pretty good instructors themselves with exam skills and I learned a lot from them. I forget how many sessions we have but they are sprinkled in the middle section of the year. We end PD sessions with a debrief on material specific to the organ system we are working our skills on, and someone from our group presents the case (half the time is also spent interviewing a standardized patient with a prescribed script). We end the year with an OSCE that takes elements of every exam day we had, it's something like an 88 point exam and we have to get such and such minimum to pass the class.

Goood.. anyone else? I need more details. I've volunteered my time for a committee to help improve the second year clinical skills curriculum at my school so I want to get a sampling of what its like at other schools.

 

[DermViser]

Goood.. anyone else? I need more details. I've volunteered my time for a committee to help improve the second year clinical skills curriculum at my school so I want to get a sampling of what its like at other schools.

If you're going to have a curriculum the way it should be is organ systems based, with your clinical skills training segmented by organ system as well. For example, learning everything about cardiovascular in a block and doing the cardiovascular clinical skills part during the same time period. As above, students should not only be hearing normal but going on the wards at an academic medical center and actually listening to abnormal - being able to identify rales, rhonchi, etc. That's the time it should be taking place. Students shouldn't be hearing abnormal stuff only when they start clerkships which by that time is too late.

Some medical schools are better at this than others, obviously.

 

[cbrons]

thanks, have a meeting monday so would help to see what more people have at their schools for pre-clinical years clinical skills training.

 

[LeftShifted]

Late morning lecture covering the physical exam (MSK, focused Neuro, CV, etc) given by relevant clinician-professor once a week, followed up by MS4 presentations to MS1s (reinforce, give some high yield stuff) and then small group physical exam / skill practice session facilitated by MS2s and Faculty.

 

[DermViser]

I'm a different breed but I still followed the "curriculum". We had a preceptor that we met with once a week and also classes. We also had mini-evals on our physical examination three times a semester.
The preceptor was hit or miss because some gave no *****. Others treated you like an intern. Nonetheless, I was doing this a lot second year.
The hours with preceptors also varied. Some had you doing 6 hours a day while others were just two hours.
In the end, I got a crash course on what I was doing wrong and things to improve. But it still didn't really teach me the important thing: what's important. I've learned there are portions of the exam you need to be adapt at doing fast and others you focus on.
Also, it's easy to do a physical exam. It's a pain in the ass to do it right or know what's "normal".

Yes. Doing a physical exam is easy. The hard part is making sure you're doing and hearing correctly and thus have the right physical exam to record (i.e. not feeling like you're feeling a pulse when you're not and then recording it) and also even when you have all your physical exam findings written - what do you actually do with it and come up with some semblance of an assessment and plan.

 

[Kaustikos]

Yes. Doing a physical exam is easy. The hard part is making sure you're doing and hearing correctly and thus have the right physical exam to record (i.e. not feeling like you're feeling a pulse when you're not and then recording it) and also even when you have all your physical exam findings written - what do you actually do with it and come up with some semblance of an assessment and plan.

Exactly.
The pride washes over quickly lol. I still nerd out over murmurs but I don't make a big deal of it. I mention it only so they know and then move on.
I've also learned, and correct me if wrong, that bringing up a concern and then asking what they think goes a long way. Live and learn.

 

[DermViser]

Exactly.
The pride washes over quickly lol. I still nerd out over murmurs but I don't make a big deal of it. I mention it only so they know and then move on.
I've also learned, and correct me if wrong, that bringing up a concern and then asking what they think goes a long way. Live and learn.

Well luckily you're going for Surgery where a daily note with physical exam, etc. is not as emphasized (esp. something like murmurs). IM is a completely different story, I think bc they bill differently.

The most ironic thing in the first 2 years is that the main emphasis is on basic science, while the Physical Diagnosis course is like this thing that is there that you do, but it's not emphasized as much so it's like something you study less bc you have other obligations. It would be great if it was all taught after basic sciences is over, but then medical school would be even longer than it already is. And it's not like any medical student will actually read Bates' Guide to Physical Examination and History-Taking from cover to cover. I think the biggest habit for students is not to accidentally "lie" on their clinical note - like documenting CTAB on lung sounds, when it's actually rales, etc.

But yes if you are able to ask interns/residents/attendings that you are hearing things or doing things right on physical that always helps.

 

[Kaustikos]

Well luckily you're going for Surgery where a daily note with physical exam, etc. is not as emphasized (esp. something like murmurs). IM is a completely different story, I think bc they bill differently.

The most ironic thing in the first 2 years is that the main emphasis is on basic science, while the Physical Diagnosis course is like this thing that is there that you do, but it's not emphasized as much so it's like something you study less bc you have other obligations. It would be great if it was all taught after basic sciences is over, but then medical school would be even longer than it already is. And it's not like any medical student will actually read Bates' Guide to Physical Examination and History-Taking from cover to cover. I think the biggest habit for students is not to accidentally "lie" on their clinical note - like documenting CTAB on lung sounds, when it's actually rales, etc.

But yes if you are able to ask interns/residents/attendings that you are hearing things or doing things right on physical that always helps.

I still have the bug where I document findings. I agree surgery has made me talk less about it... But I tried with the "this is the Med student in me" excuse and asking about my findings.
Anyways, I still have my addiction to medicine. I'm kinda blessed I have third years who have it worse lol. I get to teach them while bouncing ideas because they still have that virgin mind.

 

[NickNaylor]

Our physical diagnosis course:

Part a) Lecture based class where we had a sub specialist come in and give overview of exam elements and findings for each body system (e.g. pulmonologist for lung, vascular surgeon for pulse exams), followed by breaking into groups for practice on each other with feedback from residents & faculty in same division. Special days for more advanced stuff like eye exams where we went to the ophtho clinics.

Part b) Weekly small group (3-4 students) with a faculty preceptor who would take us to the hospital for supervised, real exams on real patients with real pathology. Would have to then practice presenting like you would as an M3 to the attending preceptor, and write full H&Ps which were graded and we were given feedback on.


edit: We also had OSCEs with SPs, but ostensibly those were supposed to be more comprehensive and focused on the communications aspects rather than learning the actual exam. The only time we really had SPs for dedicated physical exam purposes were for the breast/pelvic exam sessions.

I'm guessing this is too late for you, @cbrons, but this was pretty similar to my experience as well.