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Step-By-Step Guide
How to Propose the Elements of a Physical Exam
Dr. Mendoza has asked you to develop a plan for the physical examination for William Rand. After attending the patient interview, you will conduct some research to learn about possible diagnoses as well as what a standard examination of the hip would include to help you determine the elements to include in William’s physical examination.
Remember, the purpose of the interview and examination is to find out details about the patient’s present illness or condition, to gather a variety of data about the patient that will help in diagnosis, and to establish a positive working relationship with the patient. In the case of a sports injury, the physician gathers information about such things as pain and tenderness, swelling, and limitation of motion in the joints. You will be looking to see what information Dr. Shah’s gathered in the interview and look for ways to use it most effectively in completing the physical examination.
Getting Started
- Prepare to do your work on this task.
- Review Dr. Mendoza’s email and make sure you understand what you are being asked to do in this task.
- Briefly review each of the following documents.
- Video of the Patient Interview—You use this video to observe the interview Dr. Shah conducts with William Rand.
- Patient Interview and Physical Examination Form—This form contains Dr. Shah’s notes from the patient interview.
- Physical Examination Proposal Form (blank)—This is the template you will use to plan the physical examination for William Rand.
- Plan a time to meet with your team for your first work session.
- With your teammates, review the email from Dr. Mendoza to become familiar with your task. You may find it helpful to restate in your own words what you are being asked to do.
- Together, review the video and notes from Dr. Shah’s interview with William Rand. Specifically keep these questions in mind:
- What symptoms did William and his father mention?
- What questions did Dr. Shah ask and how did William respond?
Pay special attention to how William describes the pain he is experiencing and specific things he mentions that makes the pain better or worse. This will help guide you in planning his physical examination for two reasons: 1) it tells you what might be going on and 2) it lets you know what limitations there might be on any manipulation you will plan for Dr. Harmon to do because of the pain or discomfort it might cause.
- Familiarize yourself with the template you will use to determine the elements of the physical exam (Exam Template).
- Read the general instructions in the beginning to understand how to use it.
- Read through the template to preview the different pieces of information that you will need to research.
- Organize your team to do the work.
- It is up to your team to decide how to organize the work in this task. You may want to use the strategy of “divide and conquer” so that team members split up the work, or you may want to help each other cover the same ground. If you decide to divide the work, it is important for you to meet regularly to touch base on your progress and share the information you have found. Regardless of how you decide to break up the work, each team will need to submit a single, unified document to the mentor for review.
- For help with working as a team, managing your time, and managing a project (managing the work in a task is similar to managing a project), see the sections on Teamwork and Project Management in the General Skills Resources in the left menu.
Completing the Examination Template
In this template, you are ultimately responsible for developing a plan for the physical examination of the patient, William Rand. Taking what you know about William’s injury from Dr. Shah’s interview, you will now need to do some additional research to find out what those pieces of information mean in terms of possible diagnoses to determine the examination elements that will help to differentiate between them. Though you are not trying to create the differential diagnosis at this point, a deeper understanding the landscape of possibilities will help you to make focused and informed decisions about how to proceed with the physical exam.
- Research possible hip-related diagnoses in DATA using the clinical findings you have gathered to this point. Begin to compile a list of possible diagnoses that would explain the symptoms you know about.
- Remember: You are not trying to create a differential diagnosis yet. You are simply compiling information on some of the possible causes of William’s hip pain, in order to determine the best way to gather the additional clinical findings in the physical examination, which you will need to create a well-informed differential.
- In your notes, make a list of all the possible hip problems you think could be affecting William.
- Review other potential diagnoses in DATA that might be relevant to a hip injury.
- Review the reference document Orthopaedic Examination of the Hip for additional information about examination techniques doctors use to diagnose hip problems.
- Based on your findings from the information you have gathered in DATA and the reference document, determine which elements you would like to use in William’s physical exam.
- Using your list of possible diagnoses and the reference document on hip exams, create a list of applicable exam techniques or elements and put each element into a separate line in the first column in the template.
- In the second column, provide an explanation of what information each particular element is going to provide to enrich the understanding of Mr. Rand’s injury.
- In the third column, provide an explanation of why this information is necessary to contributing to a differential diagnosis.
Meeting to Exchange Feedback
- Meet with your team to discuss your findings and ideas. Give each team member a chance to explain his/her findings and ideas. Come to a consensus about the elements of the exam your team wants to include in their examination plan.
- Come to a consensus on the Examination Plan.
- As a team, create an Examination Plan your team that you can agree upon to submit as a group deliverable.
- If you need additional help, see the resources on Teamwork, especially the articles on collaborative group work and collaborative writing, in the General Skills Resources in the left menu.
Group Discussion
- Participate in a group discussion with your cohort (made up of all teams participating in the rotation).
- Listen carefully as each team presents their ideas for the important exam elements they chose to include.
- Participate as your mentor leads the discussion.
- Edit your work. Make any additions or changes.
- Now that you have had the chance to discuss with your peers, you may have new insights to add to your critique.
- Remember that there is not necessarily a “right” answer, so your comments may not always be identical to those from other teams. Whatever your responses, be sure that you have provided a thorough rationale to support your opinions.
- Submit your work to your mentor. Be sure to save all of your work, regardless of whether you submit it to the mentor.
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