Many doctors will fondly look back on their medical student days. Aside from grappling with theoretical knowledge, ‘hands-on’ experience was eagerly anticipated as they embarked on their journey as being doctors of the future. This was no more evident than in the teaching of physical examination skills, using their senses to deduct key observations from a patient and thereby establishing a diagnosis. Whether the ‘squeaky’ noise (like walking in fresh laid snow) of a pleural rub, observing the ‘pill-rolling’ tremor of Parkinson’s disease or feeling the ‘olive’ like consistency of a swollen lymph node, making sense of these observations is foundational in doctor training. Such abstract phenomena were and remain challenging for junior medical students to conceptualize. Inspirational teachers could, however, convey such complexities with ease. The image of my first clinical teacher spontaneously taking a group of students to percuss the side of a water fountain tank—to audibly establish the air/fluid level—as in patients with pleural effusion (i. e. a condition where there is a collection of fluid in the space around the lungs) remains as clear and remarkable to me as the day it happened. As eloquently described by our teacher, the physical effect of the lesson was analogous with the wine makers of old who percussed wine casks to see how much wine was left. Not only are such memories and sense-making long lasting, but also the impression of the expert who so effortlessly taught us. Such improvisational teaching techniques were, looking back, powerful methods that assisted our sense-making. In Harris and Rethans’ study they have masterfully explored the use of creativity and improvisation in the teaching of physical examination skills by unearthing the importance of such creative skills that all too often are below surface awareness . Yet their findings will no doubt resonate with clinicians, students and teachers alike. Whilst taking a medical history from a patient largely involves the use of language to elicit key clinical information, physical examination uses a range of sensory channels to detect relevant clinical findings. As highlighted by Harris and Rethans, physical examination skills often require more imaginative, embodied experiences for learners to conceptualize . Language alone can so often fall short of painting the entire picture of a physical sign, especially when the same clinical sign can vary from patient to patient and even from day to day. Whilst textbooks can lay down the theoretical aspects of physical examination skills and signs, they can only take learners to a point of understanding. Creative teaching techniques bring knowledge from the textbook into a more embodied, tacit experience for learners.
G. Gormley, P. Murphy
Perspectives on Medical Education