Clinical Skills Teaching for Medical Students

I taught three final year students yesterday. We went through examination of the cardiovascular system.
As usual we began with instruction on the correct method of examination. I explained that there is no difference in the method used when teaching medical students and teaching doctors attempting higher examinations such as MRCP PACES. Examination of the cardiovascular system should be done using the same method whether one is a junior medical student or a very senior physician. The difference is the senior physician will do it much better. Just think, Michael Schumacher drives a car using the same method every driver uses, he just drives better!
We went through general examination, head, hands, neck and anterior aspect of the chest.
The patient had interesting physical signs.
Initially, the students mentioned that she had a heparin infusion running and on questioning they did come out with the assumption that this indicated that the patient had either a structural or function lesion of the heart, either a valvular abnormality or an arrhythmia.
The patient had a malar flush and the students were able to interpret that this indicated mitral valve disease, with pulmonary hypertension.
The patient was in sinus rhythm with a small volume pulse; hence at this stage we were able to work out that the mitral valve was probably stenosed.
There were no obvious physical signs in the neck.
The praecordium did not show any abnormality on inspection and the positive signs
were a loud first heart sound , an opening snap, a mid-diastolic murmur with
pre-systolic accentuation and a loud second heart sound.
These physical signs were difficult to elicit initially but after the students were asked to concentrate on each phase of the cardiac cycle they were able to correctly identify these physical signs. We did get the patient to do some exercise at the end and this did accentuate the murmurs.