Stanford Initiative in Bedside Medicine
We are very fortunate to have faculty who are dedicated to teaching and who are experts in the art of the physical exam. Abraham Verghese, MD,MACP, professor of medicine and senior associate chair for the theory and practice of medicine, John Kugler, MD, clinical instructor ,and Brooke Cotter, MD, clinical instructor,are developing the Stanford 25, a new initiative designed to showcase and teach 25 fundamental physical exam skills and their diagnostic benefits to our interns.
Our ultimate goal is to have junior residents be able to teach the Stanford 25, and senior residents be able to teach and demonstrate an understanding of the advanced ancillary tests that relate to the Stanford 25.
| Stanford 25: Fundamental, Technique-Dependent Physical Diagnosis Skills |
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| 1. Fundoscopic exam, papilledema etc. using panoptic and regular ophthalmoscopes |
| 2. Pupillary responses and relevant anatomy |
| 3. Thyroid exam technique |
| 4. Examination of neck veins/JVD for both level (volume) and common abnormal wave forms; tricuspid regurgitation (ventricularization of ‘v’ waves); canon ‘a’ waves, etc |
| 5. Lung: Surface anatomy, percussion technique, finding upper border of liver dullness, finding Traube’s space |
| 6. Evaluation of PMI, parasternal heave, and other precordial movements |
| 7. Examination of the liver |
| 8. Palpation, percussion of spleen |
| 9. Evaluation of common gait abnormalities |
| 10. The ankle jerk: if performed in a recumbent patient, one must have the right technique for each of the reflexes. |
| 11. Stigmata of liver disease from head to foot: be able to list, identify, and demonstrate |
| 12. Internal capsule stroke: list, identify, and demonstrate common physical findings: lower facial weakness, distal motor weakness, hyperreflexia, absent abdominal reflex on that side, abnormal plantar (Babinski) and abnormal tone, etc |
| 13. Knee exam |
| 14. Cardiac second sounds: splitting, wide splitting and paradoxical spitting |
| 15. Evaluation of involuntary movements such as tremors, etc. |
| 16. The Hand in Diagnosis: recognize clubbing, cyanosis, other common nail and hand findings |
| 17. The Tongue in Diagnosis |
| 18. Shoulder exam (specifically testing rotator cuff tears, ac joint, etc.) |
| 19. Blood pressure assessment (this is more technique-driven than health care workers realize), Pulsus paradoxus assessment |
| 20. Cervical Lymph node assessment |
| 21. Ascites detection and abdominal Venous patterns |
| 22. Rectal Exam |
| 23. Evaluation of scrotal mass - differential between hydrocele, varicocele, spermatocele, testicular mass, etc. |
| 24. Cerebellar Testing |
| 25. Bedside Ultrasound |