Everybody wants a stethoscope to call their own

Examining bodies is a basic skill for doctors. It is still the first stage in a diagnostic pathway. Nearly every photo we see of doctors has that platinum necklace of physical examination, the stethoscope, swinging from one neck or another. Whilst effective physical diagnosis is universally recognized as essential for good medical practice, there is no unique definition, which summarizes basic practical proficiencies.

Despite centuries of developing expertise in teaching physical examination techniques, medical students’ mastery of these skills is less than optimal. In one German study, less than half the medical students in their practical year study could examine correctly four important organ systems (thyroid 38%, heart 37%, lungs 42%, abdomen 43%). When the platinum necklace was used to listen to the heart and lungs, about one third of the students could get the right answers.

But what of continuing competency?

When diagnosis moves beyond of the hands of doctors in both hospitals and the community, physical examination becomes a part of the curricula of nearly every clinical profession. Nurses, for example, have included physical examination in their courses for decades. The last copy of a manual I wrote in the late 80s on clinical examination for nurses increases in price every year on Amazon. No doubt some enterprising entrepreneur thinks it might be a collector’s edition one day. I am still asked to run refresher programs.

With diagnosis and sickness certification moving out into the community, physical examination skills are essential for other professions eg pharmacists and sports trainers. Over 75% pharmacy schools now teach a range of physical examination skills including: listening to the chest and heart, examining the abdomen, taking the pulse and temperature, checking for asthma and heart failure.

But what of continuing competency? At least in subsequent postgraduate medical training and revalidation, we can expect that doctors will be supervised and have their physical examination skills honed and peer-assessed in continuing practice.

In the other professions that pathway to ensure ongoing competency is not so clear. For example, in pharmacy, only one study has been conducted on the efficacy of physical examination training in a clinical setting; and that was on only taking blood pressure measurements. There is no published revalidation evidence from any of the other clinical professions. It is an unwelcome risk, that must be addressed soon by revalidation pathways.

One thought on “Everybody wants a stethoscope to call their own

  1. Deb, I’ve taught clinical skills to medical students in UK for a decade or more. I started on the wards, but it was better using my own patients in the community. GPs are the best teachers because they are generalists and specialists are too specialised to feel confident teaching outside their speciality.
    German medical training is much more theoretical. Our students started seeing patients within a few weeks of starting their course. What concerns me is that students see clinical examination skills as inferior to technological investigations. What’s the point of listening to the chest when you get more info from an X ray or CT scan? Being a doctor who usually works in resource-limited settings, I deplore this attitude. Maybe I’m just old school.


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