C l a s s of 2 0 17

CLINICAL SKILLS:
BASIC ANATOMY/
PHYSICAL EXAM

SYLLABUS
2013
Patrick G. O’Malley, M.D., M.P.H. Barbara Knollmann-Ritschel, M.D.
COL, MC, USA CAPT, MC, USN
Email: patrick.omalley@usuhs.edu Email: barbara.knollmann-ritschel@usuhs.edu
Module Director Module Director

Cheryl A. Markham

Program Administration Specialist

Course Administrator

Email: cheryl.markham@usuhs.edu

Phone 301-295-9922

FAX: 301-295-5913

 CLINICAL SKILLS: BASIC ANATOMY / PHYSICAL EXAM 2013-2014

MS-I CLASS OF 2017

ICM OFFICE
Phone: 301-295-9922 FAX: 301-295-5913

MODULE DIRECTORS:

COL Patrick O’Malley, MC, USA (email: patrick.omalley@usuhs.edu)

CAPT Barbara Knollmann-Ritschel, MC, USN (email: barbara.knollmann-ritschel@usuhs.edu)

Coordinator: Cheryl A. Markham (email: Cheryl.markham@usuhs.edu), Office Located in Bldg. 53, Rm 5334
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PRECEPTOR ORIENTATION: 22 Aug, 11:30-12:30, USUHS, Lecture Hall E, Bldg. C, 1st Floor

PRECEPTOR GROUP SESSIONS:

DATE TIME GROUP SUBJECT LOCATION
29 AUG (Thur) 1300-1700 1-21 Intro to Complete Physical Exam; General USU / Forest Glen
Appearance, Vital Signs, Skin, Head & Neck

5 SEP (Thur) 1300-1700 1-21 Eye/Mental Status/Cranial Nerves/Neuro Exam USU / WRNMMC / Forest Glen

12 SEP (Thur) 1300-1700 1-21 Thorax/Lungs/Axilla/Mid-Session USU / WRNMMC / Forest Glen

Preceptor Assessment

19 SEP (Thur) 1300-1700 1-21 Cardiac/Peripheral Vascular USU / WRNMMC / Forest Glen

26 SEP (Thur) 1300-1700 1-21 Abdomen/Musculoskeletal/Joints USU / Forest Glen

3 OCT (Thur) 1300-1700 1-21 1. Practice the Complete Exam USU / WRNMMC / Forest Glen
2. End of Module Preceptor Assessment

Note: On the first day, students should ask their preceptors for info on how to contact them.

WRNMMC SIMULATION CENTER

DIRECTIONS – Bldg. 3, Heroes Building, 4th floor, Simulation Section
Walk from USUHS. Follow South Palmer Rd, turn right on Brown Dr., go past Security and enter door between Security and the America
Bldg. parking garage. Follow the attached map for Bldg. 3 location.

NCA PATIENT SIMULATION CENTER (at Forest Glen): 301-295-8143

POC: Amy Risdal,Flanagan 301-295-8139 (general info on website: http://simcen.usuhs.edu/Pages/default.aspx )
DIRECTIONS – see attached detailed information for base access and parking

USUHS – MDL
USUHS, Bldg. A, 2nd floor, MS-I lab area where groups will meet and go to their assigned room.
 Class of 2017

STUDENT INSTRUCTIONS

BASIC ANATOMY/PHYSICAL EXAM SKILLS (2013)

MODULE DIRECTORS:
Patrick G. O’Malley, MD, MPH Barbara Knollmann-Ritschel, MD
COL, MC, USA CAPT, MC, USN
Email: patrick.omalley@usuhs.edu email: barbara.knollmann-ritschel@usuhs.edu

Course Administrator: Cheryl A. Markham

Phone: 301-295-9922
Email: cheryl.markham@usuhs.edu

All Schedules, Assignments and Updates Will Be Emailed to the Class

29 AUG 13 (First Session): Greet your preceptors in the MDL, WRNMMC, or the FG Sim
Center, 1300 hrs. You will receive your schedule at the Course Orientation on 22 August.

PRECEPTOR GROUP SESSIONS

(Attendance is required 1300-1630 hours):

SESSION LOCATION: Sessions will be held at USUHS (MDL Labs & conference rooms) OR at
WRNMMC (Simulation Center), OR the Forest Glen USUHS Patient Simulation Center as assigned.

DAILY FORMAT:
- Students assigned to USUHS/MDL: Report at 1300 hours to the assigned room where
your session will begin with the videotape.

- Students assigned to WR or Forest Glen SIM Centers: Report at 1300 hours to the
SIM Center to view the videotape of the part of the exam to be learned that day.
Report to your assigned room to meet with your preceptor and the rest of your group. The
format of the session will be to view the video for the organ system of the week, and then
practice the portion of the exam for that day. Before you leave each session, you must
review and practice from the beginning what you have already learned up to that point.

GRADED PRACTICAL FINAL EXAM:

You must be able to demonstrate to your preceptor an adequate complete physical exam
on your partner within 45 minutes. See the final exam checklist in your syllabus. Failure
to demonstrate adequate skills will be grounds for a failing grade and will prompt a
remediation plan during one of the two ensuing weeks after the completion of the
Fundamentals Module.

ATTENDANCE: Attendance at ALL sessions is required (even if your partner is absent).

If any problems arise, you MUST contact Cheryl A. Markham, Course Administrator,
prior to the session.

Your preceptor CANNOT excuse you from any Physical Exam session

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 PHYSICAL EXAM SKILLS INTRODUCTION

Module Directors: Patrick G. O’Malley, MD, MPH

COL, MC, USA
Email: patrick.omalley@usuhs.edu
Barbara Knollmann-Ritschel, MD
CAPT, MC, USN
email: barbara.knollmann-ritschel@usuhs.edu)

Course Administrator: Cheryl A. Markham

Phone: 301-295-9922
Email: cheryl.markham@usuhs.edu

* * * * *
The goals of this course are:
A. Perform a thorough, in-depth exam for each organ system
B. Perform a complete physical exam on a normal subject.

The physical exam will be taught in small groups with students pairing up with a new partner
each session. These sessions will begin with a demo of the physical exam skills pertinent to
the system being learned that day (done by reviewing the Bates’ tapes or preceptor
demonstration, or both). The rest of the afternoon should consist of:

1. Discussion of the reading material.

2. Practice of the techniques on your partner, guided by the preceptors.
3. Repeated practice of the total sequence learned up to that point on your partner.

COURSE INFORMATION
1. ATTENDANCE: Attendance at ALL lectures and group sessions is required. There are
only two acceptable reasons for missing class:

1) Emergency leave - authorized through the usual military chain of command

2) Being sick, as determined as being on quarters, and communicated through the

Student Health Service and the Student Affairs Office.

Elective-non-urgent medical appointments are not sufficient reason for missing class.
Scheduled trips or flights out of town are also not sufficient reasons. It is recognized
that unavoidable absences may occur and students encountering such difficulties
MUST first contact the Module Directors (COL Patrick O’Malley, MC, USA,
patrick.omalley@usuhs.edu & CAPT Barbara Knollmann-Ritschel, MC, USN,
barbara.knollmann-ritschel@usuhs.edu). It is expected that each student will
arrive on time for all sessions. Your preceptor is NOT authorized to excuse you from
class. It is expected that each student will arrive on time for all sessions.

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2. E-MAIL: This is the method we will use for notifying you about all information for this class.
Please read E-mail daily, particularly on Thursday mornings prior to your afternoon
sessions (for last minute preceptor instructions). Cheryl A. Markham's username is
cheryl.markham@usuhs.edu.

3. UNIFORM of the day for small group sessions is athletic wear (shorts, t-shirts, sports bras,
sweat pants, etc.). NO STREET CLOTHES.

4. FINAL EXAM will be an observed practical examination based on Bates’ required reading
and the physical exam practice instructions included in the syllabus. You will be required to
demonstrate a complete physical exam on your partner in less than 45 minutes. You will
be graded using the exam checklist included in your syllabus.

5. COURSE EVALUATION: Evaluation of the Course and Preceptor Sessions is a

requirement of this course and will be available on our on-line Student Assessment of
Instruction at the end of the course.

Completion of this evaluation is required for a final course grade to be issued.

Failure to do this will result in a grade of FAIL.

6. GRADING: Students will receive either a PASS or FAIL

The following is required in order to receive a PASS:
a. Attendance at ALL lectures and group sessions
b. Preparation for each session:
- Readings: Appropriate sections in Bates and this booklet prior to each session.
- Practice instructions: You must demonstrate competence with the techniques
outlined for each session.

c. PASS the GRADED PRACTICAL EXAM

d. Evaluation of Course and Preceptor: Your evaluation of the course and your

preceptor is a requirement for passing this course.

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 GRADING POLICY

INTRODUCTION TO PHYSICAL EXAMINATION SKILLS

1. Graded as a pass-fail course based on compliance with the following:

a. Attendance at all group sessions

b. Evidence of preparation for each session (adequate knowledge of the
readings, and adequate competency of the PE skills for each session)
c. Passing the graded practical examination
d. Completion of the course evaluation at the end

Any student who does not comply with the above is at risk for failing the course and will
be referred to the Education Committee for determination of a grade. All grade appeals
should be directed to the Fundamentals Module Director.

2. Attendance is mandatory at all sessions, and students are expected to arrive on time.
Students are excused from class if they are on emergency leave or if they are put on
“quarters” by the University Health Center for illness.

For any other absences, the student must first contact the Module Directors (COL Patrick
O’Malley, MC, USA, patrick.omalley@usuhs.edu & CAPT Barbara Knollmann-Ritschel, MC,
USN, barbara.knollmann-ritschel@usuhs.edu) who have the authority to approve the absence,
will determine whether the student can be excused from class. Any unexcused absence or
chronic tardiness (as reported by the student’s preceptor and/or course director) will result in a
letter being sent to the Office of Student Affairs and/or the Commandant’s Office for inclusion
in the student’s file. The student may also be presented to the Education Committee for
possible academic and/or remediative action.

3. Any issue of unsatisfactory professionalism noted by the student’s preceptor, course

director, course administrator, course staff (in MDL or at the NCA Medical Simulation
Center) or fellow students will be reviewed by the Course Director and may result in
academic or remediative action and inclusion in the student’s file, after review by the
Council of Module Directors.

Patrick G. O’Malley, MD, MPH Barbara Knollmann-Ritschel, M.D

COL, MC, USA CAPT, MC, USN
Module Director Module Director

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 READING ASSIGNMENTS

Pay Special Attention To These Sections Of The Syllabus:

1. Basic Physical Exam Sequence: Shows a suggested sequence. This sequence is a good
one to start with. As you gain more experience over the next few years, you will develop
your own sequence. The important points are:
a. General order of exam within a system is Inspection, Palpation, Percussion, Auscultation
(except for abdomen).
b. Your sequence should minimize the number of different positions for the patient.
c. Know how to modify your sequence as necessary (e.g. bed ridden or comatose patients).
d. Learn how to modify your sequence for a symptom-directed "focused" exam. (e.g. a neuro-
muscular exam on a patient with new leg weakness).

2. Reading List (see next page): Each student is REQUIRED to read the pertinent sections of
the Bate’s Textbook prior to coming to each session. Bring the book to class since you may
find it useful to refer to the text as you learn each technique.

The Bates video of each exam is also available in the CD that accompanies the text, and on
the LRC electronic resources site. You should review this before each session.

3. Physical Exam Practice Instructions: These instructions outline what you must accomplish
for each scheduled session.

4. Written Physical Exam Form: This is an example of how to logically record or present the
physical exam. This order may differ from the order you or your preceptor decide to do it.

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 READING LIST

BATE’S TEXTBOOK (11th Edition)

DATE SUBJECT REQUIRED READING

29 August
Overview: Chapters 1 and 4 (pp.105-140)
Vital Signs: Chapter 4, pp.118-127
Skin: Chapter 6
The Head: Chapter 7
The Ears, Nose, & Throat: Chapter 7

5 September
The Eyes: Chapter 7, pp. 215-232
Behavior/Mental Status: Chapter 5, pp. 151-160
The Nervous System: Chapter 17, pp. 700-738

The Cranial Nerves p. 702

The Motor System p. 708
Coordination/Gait p. 715
The Sensory System p. 719
Reflexes p. 725

12 September
The Thorax and Lungs: Chapter 8, pp. 305-318
The Axillae: Chapter 10, pp. 424-427

19 September
The Cardiovascular System: Chapter 9, pp. 360-385
The Peripheral Vascular System: Chapter 12, pp. 498-510

26 September
The Abdomen: Chapter 11, pp. 452-469

The Musculoskeletal System: Chapter 16, pp. 610-663

3 October
The Complete Exam Chapter 1, pp.13-23
Evaluation Session Basic PE Sequence

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