Advanced Physical Diagnosis Online Companion

The Doctor - Sir. Luke Fildes (1891)

This Online Companion is designed to be a supplement to the Advanced Physical Diagnosis elective, taught by Dr. Gene Corbett, M.D. at the University of Virginia School of Medicine , as well as a useful learning tool for those interested in improving their physical exam skills.  The task of turning this material into a usable product is thanks to the hard work of two fourth year medical students in the Spring of 2015 - Andy Starr and J.B. Boone. 

Users will find within this site links to current and historical articles, instructional videos, and other clinical aids that will enable them to enhance their understanding of and facility with various aspects of the physical exam.  We hope this provides a comprehensive resource for learners at all levels.  We anticipate that this guide will continue to evolve, so please feel free to contact Andy Starr, jas5ba@virginia.edu, with suggestions for how this resource can be improved.

We have organized this resource according to the major organ systems of the physical exam, which are listed in the tabs across the top of this page.  To begin exploring, simply click on the organ system of interest, where you will find relevant articles and instructional media related to that system.

Click to Access the Following PDFs:

1: A history of physical examination texts and the conception of bedside diagnosis 

2: The origins of the history and physical examination [book chapter]

3: Percussion and physical diagnosis: separating myth from science

Click to Access the Following PDFs:

1: Inadequacies of physical examination

2: Teaching cardiac auscultation to trainees in internal medicine and family practice: does it work?

3: Assessing bedside cardiologic examination skills using "Harvey," a cardiology patient simulator

4: The teaching and practice of cardiac ausculatation during internal medicine and cardiology training

Clinical observations are the currency of clinical thought and action. The quality of a clinician’s subjective and objective observations of the patient determines the quality and efficiency of the clinical care process and ultimately, the outcome of individual patient care.

Advanced Physical Diagnosis is a 2 week elective course for senior medical students at the University of Virginia. Its purpose is to provide an opportunity for advancement in physical examination observation skill and confidence.

APD Physical Examination Principles & Strategies

Observation before interpretation: It is essential for the clinician to identify and describe physical observations of the patient in order to obtain an accurate evidence base for subsequent interpretation. This, in turn, provides for examination information synthesis and diagnosis. Importantly for this elective experience, the emphasis is upon describing and documenting one’s observations before interpreting their meaning, and performing  physical examination prior to any history-taking and chart information review;

Systematic observation and expansion of the number of organ-system observations: This is an essential goal of this elective;

Achieve group observation consensus: In order to maximize accuracy and confidence in physical observation learning, it is essential to achieve complete group consensus on clinical observations made. If there is disagreement regarding an observation, patient re-examination is required until all observers agree on what is being observed;

Technological observations enhance skill and confidence in physical examination ability: Once consensus is achieved regarding a patient’s observed physical examination findings, it is essential to predict what diagnostic outcomes are most likely with clinical testing techniques (e.g., an ECG documented rhythm, bloodwork finding, chest xray abnormality, echocardiogram or catheterization observation, etc);

Patient re-examination:  Practice makes perfect;

Concurrent literature review: Skill and confidence in physical observation and interpretation is further advanced when there is sufficient biomedical understanding of the observations being made (e.g., degree of jugular venous distention vs right atrial pressure estimate, ocular venous pulsation vs intracranial pressure estimate);

Begin where the student is with respect to their physical examination skill: In order to better match PE skill teaching with student learning, it is important to begin by observing what and how the student performs physical observation at the outset of the elective (John Dewey rule).

Eugene Corbett, M.D.
Bernard B. & Anne L. Brodie Teaching Professor Emeritus of Medicine
Professor Emeritus of Nursing
University of Virginia School of medicine
Department of Medicine
Division of General Medicine, Geriatrics & Palliative Care