Patient Care

Enhancing Physical Exam Skills, and Strategies to Teach Them


HM15 presenters: Verity Schaye, Michael Janjigian, Frank Volpicelli, Susan Hunt.

Performing a physical exam is the standard of care for evaluating patients. It has been shown to have higher diagnostic utility than many technology based tests. The physical exam is the Gold Standard for dermatological and mental status assessment for which technological tests are not readily available. The tradition “laying on of hands” has important benefits for the physician patient relationship.

The teaching of physical exam skills is increasingly problematic. Barriers include attending time, comfort and skill level as well as challenges of patient comfort and potential isolation issues.

The Peyton Model provides a better means of teaching physical exam skills than the traditional “See one, do one, teach one” model. The Peyton Model has four steps:

  1. Demonstration. The teacher performs the exam at normal speed without commentary.
  2. Deconstruction. The teacher performs the exam while describing the steps.
  3. Comprehension. The teacher performs the exam while the learner describes the steps.
  4. Performance. The learner performs the exam while also describing the steps.

This approach can be abbreviated for more advanced learners with the middle two steps being combined to a discussion between the teacher and learner to highlight any differences or changes in technique. TH

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