Abstract
We greatly enjoyed Michael O’Brien’s article 1 that highlighted the strengths and weaknesses of physical examination relative to other aspects of patient assessment, including history and imaging.
We agree that a precise but thorough history provides the greatest amount of information required to formulate a diagnosis. Furthermore, there is no doubt that a poorly performed physical examination may as well not be performed at all. In an era where the standard of neurological examination performed by medical undergraduates is considered ‘lamentable’, there is concern regarding the competency of future consultant physicians.
However, we would disagree with the conclusion that ‘more emphasis should be placed on teaching students to take an accurate history and proportionally less on how to elicit physical signs’. To downplay or eliminate the need for physical examination should only be acted out by individuals who are proficient in that skill, as only they can truly judge its irrelevance to their own personal practice.
The author’s tone almost borders on that of losing hope for our bright young generation. We believe that there should be greater focus on increasing aptitude in areas of weakness. This is the only true way of increasing overall ability.
On Oxford’s undergraduate teaching programme, there is emphasis on teaching neurological examination through a variety of modalities including online e-modules, whereby video demonstrations showcase ‘impeccable’ technique. This is supplemented by bedside small group tutorials focusing on clinical examination with provision of real-time feedback. This method has proven successful in increasing student performance in recent years.
While we acknowledge that practice only makes permanent, we do believe that perfect practice (with feedback) makes perfect. This is the attitude we must adopt when training the future of our profession.