The Stanford Medicine 25 consists of hands-on sessions and online content to teach the bedside physical exam to students, residents and faculty and promote the culture of bedside medicine. LINK
The Standford 25 recognize that there is little emphasis on these physical exam skills in the 3rd and 4th years of medical school or in residency.
In the absence of a high-stakes clinical bedside final exam (as opposed to a high-stakes multiple-choice exam), there is little impetus for people to learn and master bedside skills.
Does it matter? It does to us.
The truth is, someone may be board certified in internal medicine or another specialty and no one has really ascertained that their technique in doing an ankle reflex enables them to accurately say a reflex is truly absent — take note, you would be surprised how most ‘absent’ reflexes become ‘present’ when you learn good technique.
More and more health care professionals are to do more with less. The number of stories about healthcare providers ordering unnecessary labs, images and other expensive tests are growing. We believe that caring for the patient starts at the bedside with observing, examining and connecting with our patients. This is what the Stanford Medicine 25 teaches and promotes.
In observing students and residents perform physical diagnosis maneuvers at the bedside, we observe that though they know the theory, their technique may prevent them from eliciting the sign reliably.
We find a real hunger among our residents in internal medicine to sharpen their skills at the bedside.
Many diseases (almost all of dermatology for instance) are diagnosed by bedside exam. In neurology, for example, even if the CT and MRI reveals a lot to you, only your exam can tell you what the functional consequence is in terms of motor or sensory loss or cognitive deficit.
For evidence-based medicine fans, a cautionary note here: we are not trying to prove anything, but we do want to be sure that when people write in the chart “reflexes intact” or “cranial nerves intact” or “S1 and S2 heard, no murmurs, rubs or gallops” that it is not a form of fiction, but represents an accurate observation.