the MEDICAL EDUCATOR VOL 2, No 2, February 2000  Physical exam instruction becomes new feature of 1st-year curriculum by Kristen Karig Public Relations Practice makes perfect. That’s the idea behind the introduction of physical exam instruction for first-year medical students.    First-year students practice the cardiology physical exam during a small-group session at the Center for Clinical Evaluation and Teaching. Katie Finch listens to Allison Smith's heart as Melanie Rhue, center, and Roneka Ravenel look on. Under the newly revised doctoring curriculum, first-year students began learning components of the physical exam last fall. Previously, this type of instruction didn’t begin until the second year of medical school.  The change stems from responses to a recent survey of faculty, students and alumni, and the curriculum renewal effort to better prepare students for 21st century medicine.  “Both faculty, alumni and students identified a need for earlier and more frequent exposure to the physical exam,” said Bob Mallin, M.D., assistant professor of family medicine.  Curriculum Coordinating Committee members Mallin and Ed Brown, M.D., assistant professor of medicine, are responsible for the development of the doctoring curriculum.  This newly added emphasis on the physical exam will mean students are better prepared for a second-year course in physical diagnosis and ultimately for third-year clinical rotations.  First-year students Rod Todd, Christine Lee and Iman Naseri all agree that learning the physical exam now will give them an advantage later. “The more chances we have to conduct physical exams now, the sooner we become proficient,” Todd said. “Giving us this experience early should provide some useful insight for self improvement and course improvement for next year.”  Lee adds, “learning the components to the physical exam this early allows us to make use of every opportunity, like visits with community preceptors, volunteering at Crisis Ministries, and test situations to practice our skills.”  Physical exam instruction is coordinated in the fall semester with gross anatomy topics—while dissecting the abdomen students learned the basics of performing an abdominal exam. This spring, exam instruction correlates with physiology course work—when students were discussing the cardiovascular system earlier this semester, they also learned about the cardiovascular exam. Other exams include the head, ear and neck, neurological, musculoskeletal, pulmonary, and male genital/urinary.  “Exposure to the physical exam in conjunction with our course work definitely strengthens our knowledge of the topic,” Naseri said. “It’s been very helpful to get different perspectives on one subject at the same time.”  “The physical exams also provide a setting for us to practice the medical concepts that we have learned in class,” Todd said.  Students receive initial instruction on each exam in a large group and are then divided into groups of eight to learn and practice the components of each exam. Each group is led by a practitioner who specializes in that area.  With the exception of the male genital/urinary exam (which used standardized patients), students practice performing the exams they learn on each other.  “Practicing the exam on each other and standardized patients helps students get over the initial discomfort of examining another human being,” Brown said.  Questions requiring knowledge of the physical exam are being incorporated into class tests. A physical exam component will also be added to the spring semester videotaped interview to assess students’ knowledge.  Brown and Mallin also hope this earlier introduction to the physical exam will better prepare students for National Board examinations. “It’s likely that they will have a standardized patient exam as part of their Boards,” Brown said. “As we designed this portion of the curriculum we’ve kept that in mind.”    Plans for senior psych clerkship under way by Kristen Karig Public Relations Through the new fourth-year psychiatry clerkship, Walter Hiott, M.D., hopes to give medical students more exposure to psychiatry as it occurs in outpatient settings.  Until last year, the psychiatry clerkship occupied eight weeks of the third-year schedule. To make room in the third year for the Deans’ Rural Primary Care Clerkship, psychiatry was split into two four-week clerkships—one in the third year and one in the fourth.  Dr. Walter Hiott Hiott, assistant professor of psychiatry, was named course director of the new senior psychiatry clerkship.  In the third year, students will be placed primarily in inpatient settings, where the diagnosis of psychiatric problems will be emphasized. During the fourth year, students, placed in outpatient sites, will learn interventional skills and tools for dealing with those problems.  Although only a small percentage of students nationwide become psychiatrists, it’s important for them to have the knowledge and skills to help treat people with psychiatric illnesses.  Dr. Darlene Shaw “Psychiatric illnesses are seen in almost all disciplines of medicine,” said Darlene Shaw, Ph.D., director of medical student education for the Department of Psychiatry. “It’s important to expose students to these types of problems and give them the tools they need to more effectively treat their patients.”  The fourth-year clerkship will be divided into two rotations lasting two weeks each. Hiott plans to offer students a voice in the type of outpatient experience they participate in during each rotation. Options will include child and adolescent psychiatry, geriatric psychiatry, substance abuse or community mental health. At the beginning of the clerkship, students will rank areas they are most interested in, and then be assigned to sites based on those requests.  During the fourth-year clerkship, students will meet in small groups to learn how to counsel patients about common psychiatric issues—smoking cessation, issues related to death and dying, weight management, stress management, sexual issues and chronic pain.  “Previous students have identified these areas as ones they would have liked to learn more about,” Hiott said.  In addition, Hiott plans to incorporate an independent learning component into the fourth-year clerkship. “We’re still working out many of the details, but we hope to include something along these lines to further promote active learning,” he said.  An OSCE (Objective Structured Clinical Examination) will be added to assess the knowledge fourth-year students have gained from the senior clerkship.  Current third-year students are the first to experience the split clerkship. They’ll begin the senior psychiatry rotation this July.  “We’re excited about the opportunity to build students' skills first at a rudimentary level in the third year and then give them more advanced skills when they return for the senior clerkship,” Shaw said.      Teaching tips  Making effective slides Clear purpose Your slides should have a main point and not be merely a collection of available data.  Easy to understand The main point of the slide should catch the attention of the audience immediately and should be understood soon thereafter. When the main point of a slide is unclear, the audience’s attention is focused on deciphering the slide and not on the speaker.  Free of non-essential information Information not directly supporting the main point of the slide and not important enough to be mentioned in the verbal presentation should be held in reserve to be used only if needed to answer questions.  Designed for current presentation Avoid comprehensive data tables designed for another purpose and therefore not directly relevant to the current presentation.  Integrated with verbal text Slides should support the verbal text and not merely display data generated in a study. Conversely, the verbal text should lay proper foundation for each slide. Use duplicate slides if you will refer to the same slide more than once during your presentation.  Simple format A simple, uncluttered slide format directs the attention of the audience to the main point.  USMLE Step 1 preparation activities for students Although June is still several months away, a student-led committee is preparing review information to help their fellow second-year students prepare for the big day: Step 1 of the United States Medical Licensure Examination (USMLE).  The committee, led by second-year student Jennifer Young, is collaborating with the College of Medicine Dean’s Office to develop board preparation materials. Perspectives and tips from a panel of third-year students aided the committee in their efforts. Activities in the works to help students get ready for “the Boards” are:  An Early Warning Boards Information Booklet distributed to students that includes general preparation information, study tips from third-year students, a list of commercial preparation programs and information about test anxiety. A speaker presentation in March from Kaplan Educational Center about general test preparation. Study and other resource materials are on reserve in the MUSC Library. The Center for Academic Excellence offers study skills, test preparation and time management workshops for students. The center also offers a diagnostic board review exam and an eight-hour mock exam for students. The Dean’s Office will pay for these exams for interested students. Students are advised to focus on their course studies until the end of the semester and then to plan a course of review until they take the exam.    Don't miss this March 9 - 11 AAMC Southern Group on Educational Affairs  Richmond, Va.  For more information, visit  <http://www.cbil.vcu.edu/sgea/>.  March 10 Submission deadline for AAMC Annual Meeting  The Research in Medical Education (RIME) Committee of the AAMC’s Group on Educational Affairs is accepting proposals for its 39th Annual Conference. The RIME conference—to be held in conjunction with the 111th AAMC Annual Meeting, Oct. 27 to Nov. 1 in Chicago—provides a forum for presentation and discussion of medical education research. Research papers, review papers, symposia and abstracts will be accepted. Submissions must be received by March 10.  For more information, e-mail <rimecon@aamc.org> or visit <http://www.aamc.org/meetings/annual/2000/rime>.  Gradute Medical Eduction Core Curriculum Lecture Series Dinner is provided at Thursday sessions; lunch is provided at Friday sessions.  March 2 5 - 6:30 p.m.  Preparing Your 1999 Income Taxes  Clyde Hiers, CPA, CFP, M.S. (Tax)  Room 300 Clinical Sciences Bldg.  3 Noon - 2:30 p.m.  Developing a Personal Financial Plan  Glenn Sutherland  South Carolina Brown Group  Gazes Auditorium  9 4 - 7 p.m.  Managing Your Student Loan Debt  Sandra Rollins  University of  Medicine and Dentistry of New Jersey  2 West Amphitheater  10 Noon - 3 p.m.  Managing Your Student Loan Debt  See March 10 program for speakers  2 West Amphitheater  16 4 - 7 p.m.  Evidence-Based  Medicine  John Heffner, M.D. and Barbara Tilley, Ph.D.  2 West Amphitheater  17 Noon - 3:30 p.m.  Evidence-Based  Medicine  See March 16 program for speakers  2 West Amphitheater  23 4 - 7 p.m.  Professionalism  Stephen McLeod-Bryant, M.D., Thomas Gordon, Ph.D., and Michael Vanderhurst  2 West Amphitheater  24 Noon - 3 p.m.  Professionalism  See March 23 program for speakers  2 West Amphitheater  31 Noon - 3:30 p.m.  Interdisciplinary Health Care Model  Robert Sade, M.D.  Gazes Auditorium Preregistration is required. Call 792-0761 or 792-2575.      Continuing Medical Education The following conferences are sponsored by MUSC. All conferences are to be held in Charleston, S.C., unless otherwise noted.  March 12 - 15 Neonatal Nutrition Conference  Mills House Hotel  17 - 18 Endoscopic Ultrasonography Tutorial  MUSC Campus  20 - 22 OB/GYN Spring Symposium  Charleston Place Hotel  27 - 29 10th Charleston Pulmonary and Critical Care Symposium  Charleston Place Hotel  28 - April 1 PACS, Teleradiology and Computed Radiography  Breckenridge, Colo.  Call the Office of Continuing Medical Education at 876-1925 for more information.

 

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