Medical students and interns report elements of the head and neck examination and the head-to-toe flow of the physical examination among the top 10 most technically difficult skills to master. The Year 2 Syllabus includes intensive review of clinically important head and neck anatomy coupled with hands on mentoring sessions with ENT surgeons and dentists to provide demonstration with explanation, meaningful practice with observation and feedback, and visaualization of findings using double headed otoscopes, otoscopes with cameras, and indirect and direct laryngoscopy with fiberoptic cameras and projection of images. Students are encouraged to value and describe their observations in focused physical examination write-ups, which are reviewed with formative feedback by dedicated Clinical Skills faculty.

Additional sessions for sensitive examinations including the female breast and pelvic exams and the male genital and prostate exams are led by dedicated OBGYN and Urology faculty and patient instructors help guide students through the exams and provide valuable, immediate formative assessment and feedback on techniques and approach to the patient.

The head-to-toe flow is learned in a stepwise fashion in Year 1. Year 2 Physical Examination Skills starts with intensive review and demonstration by an upper class student and a dedicated Clinical Skills faculty narrator of the tutorial for the "Physical Exam Head-to-Toe Flow Goals: Year 2," presenting an approach to an efficient choreography that minimizes patient repositioning and protects patient safety, comfort and modesty. Students are encouraged to adapt this approach to develop a personal approach to the flow that allows inclusion of all the maneuvers in a sequence that is comfortable for them. Second year student pairs practice difficult-to-master maneuvers and the flow ad lib in a Clinical Exam Suite equipped with cameras to film performance of skills and computers to playback streaming video for self and peer observation, formative assessment and feedback. Second year students also encounter patients in weekly faculty tutorial sessions providing direct observation, meaningful practice, formative assessment and feedback. These sessions also include opportunities for students to do a weekly H & P write-up with faculty and peer formative review and feedback.

In the spring of Year 2, students participate in a summative Clinical Skills Assessment exercise which is described in "Clinical Skills Assessment."

Physical Examination Skills Year 2