Professor M. Enayet Ullah
Editor-in-chief
North East Medical Journal
They are the foundations on the road to acquiring practical ability to carry out proper clinical assessment of patients for a provisional diagnosis (PD)/ Clinical diagnosis (CD) on the bed side in majority of cases. That knowledge should be imparted by the teacher/trainer and acquired and retained by the learners (students) according to the degree of dedication on the part of both the donor and the recipients.
Objectives of teaching and learning on each session have to be crystal clear both to the teacher and the
taught. The teacher has to make careful choice of his teaching materials and objectives with an avowed Intent’ to provide essential knowledge and guidance as how purposefully to carry out general and systemic examinations on various patients in the context of varied clinical history that will enable to correctly anticipate particular physical signs to be found, and then to ‘actually’ find them, grasp their significance. correlate them with the history to draw a rational and compatible conclusion as in arithmetic. Such stepwise approach and corroboration of symptoms and signs shall ensue only when the clinical history has been sequentially, purposefully and searchingly elicited, and also when correct method of physical examination has been followed. This is exactly where the teacher/trainer plays a crucial role by trying to transfer his own practical skills, acquired over a period of time, to his pulils as best as possible (similar to the transfer of industrial/ scientific knowledge and technology) by means of confident and appropriate explanation and demonstration of symptoms and signs respectively of diseases by all possible means including mock demonstrations of signs where necessary and possible. This should lead to varying degrees of embedding of those experiences in the trainees’ consciousness proportionate to the degree of eagerness and receptivity. For instance, if the history is that the parient has been episodically suffering from shortness of breath since childhood and that the episodes are invariably precipitated or aggravated by certain known allergens’ it should straightaway lead to the diagnosis of atopic bronchial asthma and the anticipated physical signs should invariably be the presence of widespread rhonchi caused by air way obstruction. Here the role of a teacher would be to teach how to correlate the history of atopy with the bronchospasm to explain the presence of rhonchi, and also not to forget to explain at the same time the difference between rhonchi and crackles, as many a time even a fresh medical graduate is found not quite confident about the difference between rhonchi and creptitaions! A brief explanation regarding the origin of crackles (crepitations) and rhonchi shall also be quite appropriate and helpful.
Comprehensive bedside teaching embracing discussion of all possible questions and crossings during professional examinations and correct response to each of them together with demonstration of commonly used clinical instruments and other items that are used in the wards and put up in examinations including various X-ray films, ECGs, various hematological, biochemical, bacteriological, hormonal and other reports and their interpretations must be ensured. During the Block Posting-period the entire process is not only reharsed but also selectively intensified by identifying the vulnerable areas with a view to mend the deficiency with utmost care to ensure optimal preparedness and performance well in time of the Red Letter Day’ that follows at the end of the 3-year-period of intensive clinical training and learning. Those learning with delight and devotion should have no reason to worry about the final outcome of their sustained academic dedication