I decided to write this topic based on a request. In the past, as part of my preparation for the MRCP exam, I wrote detailed tips every day as part of my revision, and shared these notes in a yahoo group, which I have since deactivated, and foolishly, without saving any of the material.

No worries, I can always write new ones, as long as they are beneficial.

Clinical skills, like any other skill, can not really be thought by reading and writing. It needs to be thought by the bedside. Similar to swimming, driving, riding a bike, and archery (just random examples).

A picture of archery from my first ever class. Didn’t even know the proper position back then.

There are of course (insane amounts) of theory that needs to be covered before one can start acquiring and developing their clinical skills.

Tip no1: understand the importance of clinical skills

A bird’s eye view though, would be something like this.

In the pre-clinical years, most medical schools teach anatomy, physiology, biochemistry, microbiology, pathology, pharmacology….the basic sciences.

Then, in the clinical years, the future doctor rotates through the various different specialties, mostly within the hospital, some in the community. This is when one must start to think in terms of disease, or diagnosis.

So, instead of ‘thinking’ the heart in terms of – anatomy, physiology, biochemistry, microbiology, pathology, pharmacology…the approach should be ‘the heart’ in terms of – symptoms, signs, diagnosis or differential, investigations and management.

This is of course, a very simplified version.

Now, where does clinical skills come in the history, physical exam, diagnosis/differential, investigations and treatment algorithm?

Correct, clinical skills is what makes up the physical exam. And the whole point of acquiring clinical skills is to make an accurate diagnosis/list of differentials (and hence the appropriate line of investigations/treatment).

Tip no2: Read up on the theory

Before approaching the patient, do read the books, I like Talley O’Connor. Another popular one is MacLeods, use what your school or lecturers recommend.

Youtube has a lot of very useful videos you can watch before going to class and also for revision.

This is a good one for the cardiovascular system examination.

Tip no3: Practice makes perfect

Every opportunity that you have, both in and outside of hospital, to examine a patient (or relative, friend, spouse, kids, etc) use it.

Tip no4: Get feedback

Sometimes, you have no choice but to practice alone. It is better though, to work with a partner or in groups of three (as opposed to being alone). The advantage is, you get feedback. Someone watching your every step and making sure you are doing it right. Also, when you’re beginning, you’re probably still lacking in confidence regarding your findings, so working in pairs will allow a second opinion (yeah, its definitely stony dull to percussion at the right base, yup, that sure is stage 2 clubbing).

But the best feedback you can get is from the experts. So if you are in a teaching session, volunteer yourself at every opportunity to examine in front of your lecturer, so that you get feedback, whether or not you are doing it right, or you need more practice etc.

Tip no5: Invest in your own set of equipment

It surprises me whenever I meet aspiring doctors who have not invested in their own set of equipment. True, these will be provided during the exam, but imagine getting an ophthalmoscope which is broken or worse, that you do not know how to use, in the finals. Nightmare situation right? That’s why I recommend having your own set of everything, that you are comfortable and familiar with, and bring it with you for every exam.

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Tip no6: Keep going

See a variety of patients and conditions, but more importantly, know what is likely to come out in exams.

Since the clinical exams focus a lot on clinical skills, you will be tested on this, and the patients you encounter (in the Malaysian and UK based exam systems) will have positive findings. So it is a good idea to be on a look-out for patients with signs, but dont forego the chance to examine patients who are ‘normal’ (ie have no physical findings), as the more familiar you are with what is normal, the better you will become at picking up what is not.

Hope this is helpful.