Easing JMC Second-Year Students' Transition to the Bedside
An old course, taught a new way, will send second-year Jefferson
Medical College (JMC) students from a practice lab to their first experiences
with patients more confident about their ability to take a history and perform
a physical examination.
"We have restructured the physical diagnosis course in the hope of
producing more sensitive, caring physicians, who will have superior history-taking
and physical-examination skills." So says Sylvia K. Fields, EdD, RN,
director, generalist curriculum development, JMC, one of the coordinators
of the course.
The course is structured to prepare students for entry into the clinical
phase of medical education and also aids them with the integration of basic
science material learned in class into their approach to each patient.
"The physician who is a master of these vital skills will be a superior
clinician and also play an important role in reducing the costs of medical
care," Dr. Fields said.
Other course coordinators are Thomas J. Nasca, MD, clinical associate professor
of medicine, vice chairman for education, and residency program director;
and Rachel Sorokin, MD, clinical assistant professor of medicine, assisted
by Debra Freedman.
In previous years, the course was given at the end of the second year in
a three-week mini-clerkship just before the students started their third-year
This year, the students started the program in November. They spent eight
hours over an eight-week period in the practice lab on 13 Thompson working
as partners, taking turns being doctor and patient. They practiced taking
one another's blood pressure readings, listening to heartbeats and learning
how to look for abnormalities either by running their hands over various
parts of the body (palpating) or by thumping others (percussion).
The students have at their disposal a study guide developed by Dr. Sorokin
and Dr. Field and a series of videotapes with physicians and nurse practitioners
demonstrating the correct way to perform physical examinations on every
part of the body.
The pairs of students are supervised by attending physicians, residents,
retired Jefferson physicians, fourth-year students and Jefferson Hospital
nurse practitioners, who check off a list of skills as the students perform
The restructured course has several advantages. "The students can work
more slowly, taking one body system or region at a time," Dr. Fields
said. "Being among their classmates creates a 'safe' environment where
they can learn under a lot less pressure how to examine a patient.
The students also learn at a gut level what it's like to be a patient and
how it feels when someone puts a cold stethoscope on your chest or is too
vigorous palpating your abdomen. "This is how to instill empathy because
students learn from personal experience what a patient feels during a physical
After the lab experience, the students will examine patients at Jefferson,
Pennsylvania and Methodist hospitals for 12 weeks.
"Students love this course because it makes them feel they really are
progressing toward their goal of becoming doctors," Dr. Fields said.