Friday, 2 February 2007

Examination....the wow factor

Many apologies for not writing in the last few days, but I have been busy in my teaching duties.

During my teaching at another hospital, I had finished going through the history and as a group we had made our way to see the patient.

I performed a basic but thorough physical examination and in a short time I had identified 5x splinter haemorrhages, left episcleritis and a mildly enlarged spleen.

The first year doctors seemed in awe that I had been able to find these problems.

The British medical teaching system concentrates from the very first year on how to examine the three main system and by then being fixed to different medical specialties, the student can learn the finer details of examination of each system.

As part of the final examination to become a doctor, some of it relies on being able to examine all systems to a certain level of competency and some doctors have been known to fail this part.

Later on, when the doctor wants to pursue higher level training he/she must revisit the very basic of examination skills and practise, practise and practise with the trainer being the Consultant doctors with each of them having their very own special technique of examining and with the learning doctor obtaining years of experience of the senior doctors in just a few months of training.

The higher level exams, in their final part, involve a very difficult physical examination test of 10 different scenarios which include:

  • Cardiology
  • Pulmonology
  • Gastroenterology
  • Short cases x2
  • Opthalmology
  • Neurology
  • Rheumatology
  • History taking
  • Ethical discussion
Hence, the exam involves not only knowledge of diseases, but the doctor needs to show to the examiners that they can identify the disease without questioning the patient and just through physical examination. The exam also identifies whether the doctor is able to obtain a good history in the short time allowed, whether they can actually talk to patients and deal with problematic situations.

When I did the exam, it seemed like the longest 2 hours of my life with me sitting outside the various rooms and seeing other doctors going in and then coming out looking worried.... Only half the doctors are allowed to pass this exam and with the ones failing needing to retake several months later....I was the lucky one.

I have tried to continue the same high standard of examination skills that I was taught so that the junior doctors who I teach will have the benefit of my experience and as a result, they will have more confidence in making a clinical diagnosis.

In the end, once finely tuned, the complete 3-system examination from head to toe can be done in a very short time even in the outpatient setting.

So, when the junior doctors become enthused by my examining abilities, which to me seems quite usual, it makes me want to teach that much more!!

Thanks for your support!!!

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