"Hunt of signs": a new tool to develop clinical observation among medical students





Anhembi Morumbi University


In the world of technology and fast decisions, doctors tend to give less importance to the physical examination and to rely much more on laboratory findings and subsidiary exams. In this scenario, we developed a new tool to incite clinical observation among medical students.

Summary of Work


This new activity was developed by the Internal Medicine Team of Professors.

At the beginning of their clinical rotation, students of the 5th year of the Medical Course are encouraged to observe and to document every significant clinical sign they find during their clinical rotation. After patient´s consent, every sign noted by the students is registered with photos, films or soundclips, using any hand-available tools, such as cell phones or hand cameras. We defined “sign” as any positive data observed during a physical examination (inspection, palpation, percussion and auscultation) such as jaundice, clubbing, cyanosis and edema. Also, any interesting finding observed in a X-ray or CT scan related to any specific disease or condition could be registered and explained in few words.

During their rotation, the students prepare a portfolio describing every sign they found. In the last week of their rotations, students send their “collection” of signs to the professor and the most interesting cases are reviewed and discussed in a grand round with the students, residents and professors.

This is an open activity and students are free to send as much information as they desire.

Summary of Results

Documents sent by the students range from 6 to 46 clinical signs (per student) during their 2-month rotations. Students are committed to this open activity and showed great interest in producing information.

90% of the signs documented by the students were found during the clinical examination. 10% of the findings are related to subsidiary exams such as pneumothorax (x-ray finding) and pneumoperitonneum (X-ray and CT findings).

Competition is not encouraged among students, however, small teams of students are very proud when they have the chance to expose their material at the final grand round.

Also, students are encouraged to provide feedback for this activity and one the main statements sent by them is that they became more meticulous during their physical examination because they wouldn´t want to miss any interesting clinical findings.



Using this ludic tool, students demonstrate more interest in clinical examination, “hunting” for different and rare clinical signs to share among their colleagues.

For the 21th century doctor, physical examination is still one of the most important tools in medical practice, despite of the brisk of modern technology.    


Take-home Messages

The development of tools to incite our medical students in the art of observation must be stimulated and improved.



·         Goal: develop physical examination among students - observation


·         Why?


o   Importance of clinical examination on a good working diagnosis


o   Students tend to give more importance to lab tests and othe exams…

Summary of Work


·         Tool developed by the Internal Medicine Team


·         8 months / 5th yr


·         How?


o   Record every sign


o   Rules?


o   What is a sing?


o   Professor collect the signs and elect 5 cases – ground Round

Summary of Results


·         Final results


·         100% of participation


·         6-46 signs sent


·         Commitment to CE


·         Students are more active


·         Satisfaction for having a case selected

Take-home Messages
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