Lessons from Clinical Skills Examination

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The air was filled with the ringing of bells, indicating to each examinee that the clock began counting down or that their time was up and it was time for them to exit the examine room. 5 minutes was all the time each examinee received, to truly shine.

As I stood in front of the exam room door, reading the instructions and praying that the room contained a personable invigilator and an easy cooperative simulated patient, I tried my hardest to remain calm and to remind myself that I knew the exam like the back of my hand. This was just another practice session for me to demonstrate to myself and to the invigilator just how much I knew and understood.

Introduction and seeking permission, was perfect, general inspection at the foot of the bed priceless; inspection of the face and neck could not have been better. As the examination progressed and I continued signposting, I realized that as I instructed the patient to "hook both index fingers" so that I could determine whether or not Shamroth's window was preserved, my hands began to shake almost uncontrollably. It was at that moment, my skill [in my opinion] failed. My percussions were mediocre as I moved from the supraclavicular; infaclavicular then on to the chest wall and the axilla.

Trying to save myself and the remainder of the examination via proper auscultation techniques and rapport building it seemed all too late. Embarrassed and with my confidence shot, I inquired whether or not he was experiencing any pain before asking him to sit forward and as he did so it was as if I was faced with a brick wall. Forgetting to comment on the findings, following my inspection of his back,  I was caught trying to decide whether or not I should proceed by repeating all of the steps I performed anteriorly, now posteriorly or just go right to examining his lymph nodes. Before I was able to decide what to do next, there was that bell.

Just like that time had escaped and not one more second was afforded me, not even to complete a lymph node exam or to comment on what testing I would request for further investigations. What else could I do now? I thanked the patient with a smile, shook his hand, thanked the invigilator and exited the room.



We all need moments such as these to be able to address and perfect our strengths and weaknesses. My greatest lesson thus far thanks to these continuous assessments is summed up in the following quote by Napoleon Hill "desire is the starting point of all achievement."