What if medical residency not only deepened a doctor's knowledge of the body, but also revitalized her people skills? In a recent opinion piece (subscription required), a team of Stanford doctors make the case for continuing to teach clinical skills and make high-stakes assessments of them a requirement for postgraduate medical certification. Currently in the U.S., teaching and assessing such skills is only required during the first two years of medical school.
Evaluation of a resident's history taking and physical examination proficiency with real patients by an independent faculty-level examiner - a practice that has continued and been refined in Canada and the U.K., but which fell by the wayside in U.S. medical education decades ago - would produce better doctors as well as better patient experience, the piece argues.
I spoke about the Journal of the American Medical Association article's perspective with Abraham Verghese, MD, one of the authors, who explained that clinical-skills assessments during residency disappeared in the U.S. because of a feeling that they were too subjective. He continued:
With the ascendance of technology there began to be less and less emphasis on what I call the plucking of the low hanging fruit - the stuff that’s obviously on the body that you can easily diagnose. We got into this situation where very often we miss the obvious, and usually we wind up using a test to tell us something that is actually staring us in the face.
The article outlines four principles that guide Stanford Medicine's approach to teaching bedside manner and describes a Stanford pilot program for an assessment that's modeled on the Membership of the Royal College of Physicians (MRCP) PACES examination, which is administered around the world.
Verghese notes that Stanford is fortunate to have many attending physicians who are adept in bedside manner and interested to improve further. He remarks about faculty investment in the program, "They’ve been very willing and eager to learn these skills, and we are very willing and eager to teach it."
Previously: Abraham Verghese discusses reconnecting to the patient at the bedside, Abraham Verghese discusses the importance of hands-on patient exams, Exploring the “fading art” of the physical exam and Abraham Verghese at Work: A New York Times profile
Photo by Official U.S. Navy Page