An exploratory study into the teaching of clinical examination skills in advanced practice
Clinical examination skills are vital for the accurate assessment and diagnosis of patients. These skills also allow clinicians to differentiate between pathology requiring investigation or treatment and normal anatomy or physiology. This allows clinicians to avoid unnecessary tests and to be able to reassure a patient that their symptoms do not require treatment. However, an incomplete or faulty clinical examination can lead to missed diagnoses and patient harm. Although comprehensive clinical examination skills training is provided in the undergraduate curriculum of medical schools in the UK, little is known in relation to the teaching provided for nurses and allied health professions working in advanced practice roles. This survey sought to explore this phenomenon and uncover clinicians' experiences with regard to being taught a selection of specific clinical examination skills in theory and in practice, those skills being the core system examinations (respiratory, cardiovascular and peripheral vascular, abdominal, central and peripheral nervous systems) and a number of focused examinations (digital rectal and examination, thyroid, breast and genital examination for males and females). The findings demonstrate a concerning variability of educational experiences and a lack of educational coverage of some of the basic clinical examination skills in both theoretical and practical terms. These findings provide an insight into areas of future higher education curricula development as well as workplace mentoring and learning.
It has been suggested that the clinical examination of a patient is a dying art (Uddin, 2019), and that clinicians' loss of aptitude in this area has contributed to an inability to formulate an appropriate differential diagnosis and hampered the ability to diagnose (Asif et al, 2017). Within the context of modern medicine, where investigations using radiology and ultrasound abound, it could be argued that the need for a thorough clinical examination has been diminished (Elder et al, 2017; Elzanaty et al, 2019). However, such investigative modalities are not globally available and, where they are, access to them is neither unlimited nor without expense. In some cases, reliance on such investigations has been highlighted as a ‘significant threat to patient safety’ (Asif et al, 2017). Furthermore, we know that incomplete or faulty clinical examinations are a source of incorrect diagnoses (Graber et al, 2005) and that omitting examination techniques altogether can lead to diagnoses being missed (Bordage, 1999), with some researchers specifically noting that:
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