Clinical skills for medical students: a hands.on guide

Ian Bickle, Paul Hamilton, David McClusky, Barry Kelly

PasTest. 2001, £11.95
ISBN 1901198863

Rating: ***

There is a new contender in the fight for a place in your white coat pocket. Comprehensive and comprehensible, Clinical skills for medical students describes the procedure for examining each of the five major systems: cardiovascular, respiratory, alimentary, musculoskeletal, and nervous. The accompanying illustrations are not great, but they are usefully incorporated into the text on the appropriate page, so the reader never faces the frustration of flipping repeatedly from cover to cover in search of an elusive “figure X.” There are boxed sections containing essential learning points, tips on techniques, and acronyms to aid learning. And within its 140 odd pages, this book contains more bullet points than the opening sequence of the A team.

So far, so good, but much of the above is true of many other texts on clinical examination: what sets this one apart?

For one thing, Clinical skills for medical students goes beyond being a mere introduction to clinical examination. It offers brief, but valuable, chapters on other essential clinical techniques such as assessing x ray films and documenting case histories. It is also far more comprehensive than most pocket books. The chapter covering examination of the musculoskeletal system is particularly thorough—describing the gate, arms, leg, and spine (GALS) screening test as well as specific procedures for examining the spine and major joints. Furthermore, this book offers detailed coverage of all those examinations that do not fit easily into the systems structure and are therefore often omitted from student guides. Examination of virtually every function and body part, from mental state to rectum, is covered in this guide.

There are minor annoyances. For example, some of the bullet-pointed lists seem to muddle the essential with the extraneous. So in a list of “objects and belongings” to look out for when examining a patient, the must-not-miss Medic Alert bracelet is listed alongside the informative, but not nearly so dangerously overlooked, “tobacco products.” Still, this sort of thing can be readily remedied with a dose of fluorescent highlighter.

It is also worth noting the book's limitations: it offers instruction, but not understanding. In the chapter on the cardiovascular system, for instance, we are instructed to “check for hepatojugular reflux” and told how to do this. However, we are not told what hepatojugular reflux looks like, or what clinical significance it has.

Of course, a text this size cannot contain everything, and the introduction rightly acknowledges that effective clinical examination demands not only knowing “how to do the procedure” but also “why the procedure is being carried out.” If you want to know “why,” you are still best off speaking to your senior house officer. For those of you wanting to know “how to,” with the aim of passing objective structured clinical examinations (OSCEs), picking up basic signs of pathology on the ward, and perhaps impressing a consultant or two along the way, it would be worthwhile making room in your pocket for this book.

Andrew Moscrop, final year medical student, Edinburgh University
Email: andrewmoscrop@yahoo.com


studentBMJ 2002;10:1-44 February ISSN 0966-6494