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Posted By: Debra A. Danforth, DNP, APRN
January 05, 2021
This year has changed how we teach health assessment or provide objective structured clinical examinations (OSCE) to our students. Now, everyone has gone to Zoom or is using a simulation product. This is exactly what happened at the university where I teach. Here is how we worked through teaching our students:
We worked with standardized patients (SPs) online instead of in person. The students conducted the history with the SP and then told the faculty which physical exam they would like to perform. The students would explain step by step what they would be doing. For example, if the student was performing a cardiac exam inspection, they would state "looking at the chest and see no scars, rashes, or heaves"; if they were performing palpation, they would state "would palpate the point of maximal impulse at the 5th intercostal space"; if they were performing auscultation, they would state "would auscultate with the diaphragm at the aorta, pulmonic, Erb's, tricuspid, and mitral, and then repeat with the bell". If there was a finding, the faculty would provide the answer.
We continued to work with the SPs and taught them how to give responses to students’ physical exam questions while the faculty observed and scored. We also provided the students with a lecture on telehealth and had them incorporate it into their next patient encounter. For example, when checking for respirations we had the patient raise their finger every time they took a breath, and the student would count over the course of 15 to 30 seconds to come up with the total respiration in a minute. For the range of motion, students demonstrated to the SP what the movement should look like before observation. To hear breathing, we had students ask the SP to get close to their microphone and breath in and out (we had asked the SPs to wheeze); to look at skin, we provided a picture for the SP to show; for depression scale or Montreal Cognitive Assessment, we provided the SPs with the results of each tool.
This Fall we brought students back to campus and paired students of the same gender to practice each physical exam (heart; lung; abdomen; head, eyes, ears, nose, and throat; musculoskeletal; neurologic) on each other for the entire semester. We had two different groups to reduce the number of people in the rooms: Group A would come one week and Group B would come the other week. So, if anyone had COVID-19 symptoms, they would have time to recover before their next session. For safety, each student did an online check-in before coming to the clinic; once approved to come in, they wore a mask, stood 6 feet apart, cleaned their hands, and then put on gloves for the entire encounter. We also provided each student with a gown and drape to use during the session. Afterward, staff went around and cleaned each room with CaviWipes, washed the laundry, and left that room empty for the next 30 minutes. We were using alternate rooms to ensure all rooms would stay safe. This worked very well.
Most recently, we have had the students interview the SP online the day before coming to class, and then perform the physical exam on their partner (or Harvey manikin for the heart exam) with findings. When they were finished, the students either wrote a note or provided the faculty with an oral presentation that included subjective, objective, differential diagnosis, and plan of care.
Hope these tips help you during this pandemic—I'm always available to discuss teaching options further.