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Teaching Medical Exam Techniques to Standardized Patients: Goals & Objectives, Study notes of Communication

The goals and objectives of Focused Exam (FEX) Standardized Patient Teaching Associate (SPTA) sessions. The sessions aim to teach medical students the basic techniques of physical examinations in an organized and systematic manner, while ensuring a non-threatening learning experience. SPTA sessions also emphasize the importance of the doctor-patient relationship and patient communication. Students should be able to perform examinations respectfully and effectively, communicate clearly with patients, and develop a partnership with them.

What you will learn

  • What are the goals of the Focused Exam (FEX) Standardized Patient Teaching Associate (SPTA) sessions?
  • What skills should medical students be able to demonstrate after completing the SPTA sessions?
  • How do Standardized Patient Teaching Associates (SPTAs) help medical students learn physical examination techniques?

Typology: Study notes

2021/2022

Uploaded on 09/12/2022

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Focused EXams (FEX)
STANDARDIZED PATIENT TEACHING ASSOCIATE (SPTA) SESSIONS
GOALS AND OBJECTIVES
THE GOALS OF THE FOCUSED EXAM (FEX) SP TEACHING SESSIONS:
1. To teach the basic techniques of the head-to-toe physical examination.
2. To teach students to perform the physical examination in an organized and systematic
manner.
3. To provide a non-threatening learning experience that prepares students to examine
and interact with patients in a manner that respects the physical and emotional comfort
of the patient.
4. To teach the importance of the doctor-patient relationship to the therapeutic outcome.
5. Ensure that all students meet a minimum level of competence of the physical exam
technique and patient communication through a comprehensive Screening Examination
at the end of the course.
BY COMPLETION OF THE SPTA SESSIONS, STUDENTS SHOULD BE ABLE TO:
1. Perform the basic physical examination techniques in an organized and systematic
manner.
2. Examine and interact with a patient in a manner that respects the physical and
emotional comfort of the patient.
3. Give clear and concise instructions and explanations to the patient before beginning
a procedure.
4. Use language the patient understands.
5. Give reassurance and feedback of findings throughout, when appropriate.
6. Demonstrate the ability to notice and respond to the patient’s verbal and nonverbal
communication of discomfort and concerns.
7. Understand the value of the doctor-patient relationship on the therapeutic outcome.
8. Demonstrate the ability to develop a partnership with patient.
9. Allow opportunities for patient’s questions.
10. Answer patient’s questions thoughtfully and respectfully.
11. Express unconditional positive regard for the patient.
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Focused EXams (FEX)

STANDARDIZED PATIENT TEACHING ASSOCIATE (SPTA) SESSIONS

G OALS AND O BJECTIVES

THE GOALS OF THE FOCUSED EXAM (FEX) SP TEACHING SESSIONS:

  1. To teach the basic techniques of the head-to-toe physical examination.
  2. To teach students to perform the physical examination in an organized and systematic manner.
  3. To provide a non-threatening learning experience that prepares students to examine and interact with patients in a manner that respects the physical and emotional comfort of the patient.
  4. To teach the importance of the doctor-patient relationship to the therapeutic outcome.
  5. Ensure that all students meet a minimum level of competence of the physical exam technique and patient communication through a comprehensive Screening Examination at the end of the course.

BY COMPLETION OF THE SPTA SESSIONS, STUDENTS SHOULD BE ABLE TO:

  1. Perform the basic physical examination techniques in an organized and systematic manner.
  2. Examine and interact with a patient in a manner that respects the physical and emotional comfort of the patient.
  3. Give clear and concise instructions and explanations to the patient before beginning a procedure.
  4. Use language the patient understands.
  5. Give reassurance and feedback of findings throughout, when appropriate.
  6. Demonstrate the ability to notice and respond to the patient’s verbal and nonverbal communication of discomfort and concerns.
  7. Understand the value of the doctor-patient relationship on the therapeutic outcome.
  8. Demonstrate the ability to develop a partnership with patient.
  9. Allow opportunities for patient’s questions.
  10. Answer patient’s questions thoughtfully and respectfully.
  11. Express unconditional positive regard for the patient.

W HAT IS A STANDARDIZED PATIENT TEACHING ASSOCIATE?

A Standardized Patient Teaching Associate (SPTA) is a person who has been trained to use his/her body to instruct and evaluate medical students in the following areas:

  1. Teach and evaluate the basic techniques of the head-to-toe physical exam.
  2. Teach students to perform the physical examination in an organized and systematic manner.
  3. Help students learn to develop a partnership with patients.

ADVANTAGES OF STANDARDIZED P ATIENTS

  1. Availability: Due to health care reform, there are fewer real patients in the system and they enter later in the disease process.
  2. SPs reduce risk and anxiety of examining real patients.
  3. SPs reduce embarrassment of students about their novice status as they learn to perform the physical exam and interact with a patient.
  4. SPs can authentically simulate an illness at any stage of the disease process, from acute presentation to chronicity. They have the ability to compress the natural history of an illness so that the student can obtain a better understanding of the disease process.
  5. SPs can provide feedback from the patient’s perspective: Patients normally will say nothing to a physician who has not interacted with them in a positive manner, but may not comply with his/her instructions, and is likely to go to another physician in the future.
  6. Consistency and accuracy: Standardized patients on average are more than 90% accurate in portraying details of a case and about 80% accurate in reporting checklist items of performance. 73% of SP recording errors are in the examinees’ favor. TULANE SPs AVERAGE 92% ACCURACY.

Communication Skills

Communication skills are fundamental to the history and to the physical exam. The patient history has three essential functions: establishing rapport, gathering information, and negotiating management plans. A good history will yield a diagnosis 90% of the time; the physical examination is confirmatory. Physical examination is a very important time to maintain patient rapport and to attend to patient comfort and anxiety. It can also be an efficient time to conduct a review of systems, as long as you explain to the patient what you are doing and why.

COMMUNICATION S KILLS

  1. Greet the patient in a warm and courteous manner.
  2. Maintain good eye contact.
  3. Place yourself at eye level of the patient / avoid hovering over patient.
  4. Address patient as Mr., Mrs., or Ms.; unless otherwise requested.
  5. Ask open-ended questions.
  6. Let the patient finish without interrupting.
  7. When necessary you may ask directed questions.
  8. Let the patient know you are listening: nodding your head, repeat what patient says, or simply say “um hum.”
  9. Never be judgmental.
  10. Show empathy.
  11. Always ask the patient if there is anything else he/she needs to address.
  12. Do not use medical terms or jargon.
  13. Allow opportunity for patient’s questions. Answer them thoughtfully and respectfully.
  14. Keep in mind the value of the doctor-patient relationship on the therapeutic outcome. A patient is more likely to comply if you have established rapport.
  15. Do not be afraid of periods of silence.

COMMUNICATION S KILLS SPECIFIC TO P HYSICAL E XAM

Before beginning each area of a physical exam, you should tell your patient:

  1. What you will be doing.
  2. Give a simple explanation of reason for the exam.
  3. Any instructions regarding patient participation.
  4. Periodically, give reassuring statements and provide findings when appropriate.
  5. Periodically summarize your understanding of what the patient has told you.
  6. Approach patients respectfully with regard to their modesty and emotional anxiety. Remember that patients are often stressed by the circumstances of their illness and the clinic environment.
  7. Pay attention and respond to the patient’s verbal and nonverbal communication of anxiety and discomfort.

Dress For Teaching

Abdomen – patient gown with elastic waist shorts and sports bra. Must be able to lower shorts to pubic line.

Cardiovascular - patient gown and shorts (no bra). Part of what we teach is proper draping, both male and female SPTAs must wear a gown and demonstrate.

HEENT - wear loose neck, sleeveless top.

Pulmonary – patient gown and shorts (no bra). Both male and female SPTAs must wear a gown and demonstrate draping.

Musculoskeletal – patient gown, shorts, sports bra.

Neurology – patient gown, shorts, sports bra.

Vital Signs – short sleeve or sleeves top.

 Wear socks or slip-on shoes in center at all times.

 No cut-offs, super short skirts or shorts, or halter tops.

 Clean clothes and body.