Stanford 25 is an innovative program focused on teaching residents advanced physical exam skills. It is built on the principle that, like any other skill, technique matters. As medicine residents spend increasing amounts of time poring over the electronic medical records, technique and true bedside skill suffer. By demonstrating 25 technique-dependent physical diagnosis maneuvers, then having residents practice using the maneuvers and teaching the maneuvers, residents develop a repertoire of skills they can teach at the bedside.

The Stanford 25 team is part of the Program in Bedside Medicine, led by Dr. Abraham Verghese, MD, MACP, Vice Chair for the Theory & Practice of Medicine. The group’s research interests are in developing bedside skills, in teaching ultrasound, in the ethnography of the patient-physician relationship, and in evaluating clinical skills. Skilled clinicians of the Program in Bedside Medicine, as well as master clinicians throughout the Divisions and Departments, are invited to conduct demonstrations, integrate evidence and experience to create a top-notch physical exam curriculum.

Stanford 25 educational sessions are held every two weeks throughout the year and typically involve a live patient and a demonstration of physical diagnostic techniques by an expert clinician. Residents become comfortable with this skill, and are then tasked with teaching this skill to their peers. The end result is the training of residents to become skilled clinicians with great dexterity in the physical exam.

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The 25 Techniques

  1. Thyroid Exam
  2. Gait Abnormalities
  3. Spleen Exam
  4. Liver Exam
  5. Liver Disease, Head to Toe
  6. Ascites & Venous Patterns
  7. Knee Exam
  8. Shoulder Exam
  9. Lymph Node Exam
  10. Deep Tendon Reflexes
  11. Cerebellar Exam
  12. Fundoscopic Exam
  13. Pulmonary Exam
  14. Precordial Movements
  15. Cardiac Second Sounds
  16. Neck Veins & Wave Forms
  17. BP & Pulsus Paradoxus
  18. Ankle Brachial Index
  19. The Hand in Diagnosis
  20. Bedside Ultrasound
  21. Rectal Exam
  22. Pupillary Responses
  23. Involuntary Movements
  24. Internal Capsule Stroke
  25. The Tongue in Diagnosis