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Education and Training

Teaching Physical Assessment Skills in New & Innovative Ways


Students Test Interactive, Computer-Based Physical Exam
A new digital learning tool is revolutionizing medical education at The Ohio State University College of Medicine and Public Health (COMPH). The adoption of this technology promises to accelerate the already innovative educational profile of the COMPH nationwide, possibly even worldwide.  

 Interactive Physical Exam

The Interactive Guide to Physical Examination, launched as a pilot in September 2002 with second-year medical students, allows learners to "perform" a patient physical examination on the Web with just the click of the mouse. Students can listen to breath sounds, watch the heart chambers at work, and take a person's blood pressure, among other exam tasks.

The guide includes eight basic physical examination areas: head and neck, pulmonary, cardiovascular, abdominal, musculoskeletal, neurologic, and male and female genitalia.Together, these content modules contain more than 45 digital video clips and 45 colorful interactive multimedia elements such as pop-ups, animation and illustrations that usher students through the process.

A Tool Like No Other
The Interactive Guide to the Physical Examination- now available as a CD-ROM - is unique because of its comprehensive scope and interactive format. "Other schools have a component of the technology, such as a Web site on heart sounds, but nothing this comprehensive," says Doug Knutson, MD, assistant professor of family medicine, who assisted project director Cynthia Kreger, MD, associate professor of clinical general internal medicine, in developing the content.

Other medical education technology tools tend to be video-based, adds Timothy Cain, Ph.D., director of Technology-Enhanced Learning for Medical Education at the College and leader of 2md :: Medical Multimedia Design, the multimedia team that developed the application.

Development of the Interactive Guide was spurred by concern about students' declining physical examination skills," Knutson says. "With other diagnostic technology available, emphasis on the physical exam had waned over time."

From Proposal to Pilot
Creation of the Guide began in 1999 when Larry Gabel, PhD, academic vice chair, Department of Family Medicine, along with department colleague and principal investigator Holly Cronau, MD, assistant professor, were awarded a federal Health Resources and Services Administration grant to develop a "statewide classroom to train tomorrow's physician's today."

The grant proposal for a technology to teach basic clinical skills and offer a real-time, Web-based format that also could be used in distance learning, Gabel says, led to identification of the physical examination skill set. Gabel, Knutson and Kreger collaborated over the next three years with Cain's team of multimedia design experts to create the digital learning tool.

Feedback from the pilot group of second-year medical students is being gathered in November, but students have been raving about the guide from the start, Knutson notes. "They're more confident about patient interactions, having done the basics with a 'virtual' patient."

The Guide has many benefits, say its developers. It improves patient care by increasing student exam skills and addresses the need to contain healthcare costs. It also helps educators focus or dovetail assignments with the Web site. And it readily responds to individual learning styles.

This technology also shows that "classrooms aren't defined by space, time or even who is present," Gabel notes. And, he says, the possibilities are endless. "Our learner can be a physician seeking continuing medical education credit or a second-year medical student in Zimbabwe."

Next Steps
The Guide already has generated tremendous interest from medical, physician assistant, allied health and nursing schools. And the Department of Family Medicine has received another three-year federal grant to apply the same technology to the next critical practice skill - diagnosis - learned during the third and fourth year of medical school.

The COMPH is taking a leading role in advancing tomorrow's medical classroom, say clinical educators. "The Guide reflects the College's goal of decreasing lecture time and increasing computer-based technology in medical education," Knutson says.