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Title: Will clinical signs become myth? Developing structured Signs Circuits to improve medical students' exposure to and confidence examining clinical signs.
Austin Authors: Merriott, Dominic;Ransley, George;Aziz, Shadman;Patel, Krushna;Rhodes, Molly;Abraham, Deborah;Imansouren, Katba;Turton, Daniel
Affiliation: Intensive Care
Internal Medicine Trainee, University College London Hospitals NHS Foundation Trust, London, UK..
Emergency Medicine Specialty Trainee, London, UK..
Foundation Doctor, King's College Hospital NHS Foundation Trust, London, UK..
Foundation Doctor, Barts Health NHS Trust, London, UK..
Anaesthetist at Barts Health and Honorary Lecturer at Queen Mary's University of London, UK..
Issue Date: Dec-2022
Publication information: Medical education online 2022-12; 27(1): 2050064
Abstract: Correctly eliciting and interpreting physical examination (PEx) signs contributes to successful diagnosis and is fundamental to patient care. A significant decline in the time spent acquiring these skills by medical students, and the decreased ability to elicit and recognise signs is widely acknowledged. However, organising teaching to counteract this in the busy clinical environment is challenging. We evaluated the prior exposure to clinical signs, and experience of examination teaching among a cohort of final-year medical students. Following this, we assessed the utility of a structured circuit-based approach (Signs Circuits) using hospital inpatients and junior doctors to provide high-yield PEx teaching and overcome these limitations. Qualitative and quantitative survey feedback, including a standardised list of 62 clinical signs, was sought from final-year medical students during their rotations at a teaching hospital in London, UK, before and after the provision of Signs Circuits. Prior to the course the 63 students reported limited exposure to even the most common clinical signs. For example, the murmurs of mitral and tricuspid regurgitation and the sound of lung crackles eluded 43%, 87%, and 32%, respectively. From qualitative feedback, the reasons for this included that much of their prior PEx experience had focused on the performance of appropriate examination steps and techniques in patients without pathology. During the course, students were exposed to an average of 4.4 new signs, and left with increased confidence examining and eliciting signs, and a firmer belief in their importance to diagnosis. Medical students continue to have limited exposure to clinical signs in medical school. This signs-focused approach to PEx teaching is an effective and reproducible way to counter the deficiencies identified in signsexposure.
DOI: 10.1080/10872981.2022.2050064
ORCID: 0000-0001-7192-9309
PubMed URL: 35388743
PubMed URL:
Type: Journal Article
Subjects: Physical examination
clinical signs
clinical skills
examination skills decline
Appears in Collections:Journal articles

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