clerkship handbook - University of Hawaii – Department of Medicine

1. The patient always comes first - be considerate of his/her comfort and privacy.
2. Students WILL wash their hands before each examination.
3. While the patient must adequately disrobe, modesty should be respected at all times.
4. The examiner should explain what he/she is doing during the examination.
5. Never force a procedure on any adult patient.
6. Reassure the patient during the examination.
7. Be serious, yet maintain an appropriate sense of humor.
8. Always be gentle -- a physical examination may be slightly uncomfortable if an
abnormality is present. It should never be painful.
9. Be systematic and thorough.
Physical examination techniques and skills that are required for MD 1 are outlined in
the MD 1 Handbook and are described in detail below , and in your physical diagnosis
textbooks.
B. STEPS OF THE BASIC PHYSICAL EXAMINATION SEQUENCE (BPES)
These are the steps included in the student Basic Physical Examination Sequence
(BPES). They should be performed by the student in every complete physical
examination. The BPES should be completed in 30 minutes.
Patient sitting: physician facing patient
1. GENERAL APPEARANCE: Inspect for habitus, level of consciousness, movement,
comfort, affect.
2. VITAL SIGNS: Determine body temperature - read thermometer.
Determine radial pulse - rate per minute and
compare bilateral radial pulses simultaneously.
Determine respiratory rate per minute (w hile
comparing radial pulses).
Determine blood pressure - place BP cuff 2.5 cm
above antecubital fossa and at level of atria.
Determine BP by unilateral palpation of radial pulse
and then by auscultation of the brachial artery in the
antecubital fossa.
3. SKIN: Inspect for overall color, hair and gross lesions. (Inspect and palpate skin in
detail under each regional exam below).
4. HEENT: HEAD: Inspect face for symmetry, abnormality. Inspect and
palpate scalp.
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