In the Osler program, we firmly believe that the patient is the most valuable source of information about their illness. Many studies have shown and confirmed that the majority of diagnostic information comes from the patient’s history. Many of physicians’ critical responsibilities can only be performed at the bedside – not only diagnostic information gathering and clinical reasoning, but also exploring patients’ values and preferences, counseling, and simply being present during difficult times.  

Bedside rounds are the heart of our training program. 

Despite the proven benefits of time spent directly with patients, trainees spend little time at the bedside in the modern academic hospital and often sense a decline in their physical exam skills as they matriculate through residency. Our core teaching services are structured to maximize time at the bedside. ACS rounds allot 2 hours each morning for dedicated bedside rounds on new patients for the entire team; during this time, the post-call intern presents overnight admissions at the bedside, with real-time evaluation by the on-call intern and ACS. The new patient SAR provides teaching at the bedside and in short didactic form. In the afternoon, the ACS and supervising senior resident round to see and examine patients, ensure they are updated on their plan of care, and provide advanced teaching. In the afternoon, the ACS and supervising senior resident round to see and examine patients, ensure they are updated on their plan of care, and provide advanced teaching. We believe increased time at the bedside improves satisfaction and engagement in the educational environment and decreases burnout. The Osler service is structured to maximize this time.

Dedicated physical exam teaching sessions to improve observation and physical diagnosis skills. 

While rotating through the Medical Progressive Care Unit (“step-down” level care), our interns and junior residents accompany medicine and neurology faculty to the bedside 3 days per week to practice the art of observation and physical diagnosis. Learning the principles and skills of observation and the hypothesis-driven physical exam allows our learners to obtain the most information about their patients while practicing compassionate, patient-centered care. 

POCUS curriculum in subspecialty environments augments bedside skills.

In 2025, we are launching a novel POCUS curriculum designed to ensure that all of our housestaff rotating through our subspecialty services are competent in obtaining critical views in cardiac, pulmonary, and abdominal point-of-care ultrasound. We view POCUS as an important tool to reinforce anatomy and physiology to underscore history and physical findings, and in the right hands, as a useful diagnostic tool.

Publications Related to Clinical Skills

• Internal Medicine Intern Performance on the Gastrointestinal Physical Exam
• Use of a Real-Time Locating System to Assess Internal Medicine Resident Location and Movement in the Hospital
• Relationship of Physical Examination Technique to Associated Clinical Skills: Results from a Direct Observation Assessment
• Seven reasons why the physical examination remains important
• Strategies to Improve Bedside Clinical Skills Teaching
• Peabody's Paradox: Balancing Patient Care and Medical Education in a Pandemic
• Assessing physical examination skills using direct observation and volunteer patients
• The genealogy of teaching clinical reasoning and diagnostic skill: the GEL Study
• The Modern Physical Exam - A Transatlantic Perspective from the Resident Level
• Reinvigorating the clinical examination for the 21st century
• Strategies to Avoid the "Hemolyzed" Physical Examination
• Use of a Real-Time Location System to Understand Resident Location in an Academic Medical Center
• The physical examination, including point of care technology, is an important part of the diagnostic process and should be included in educational interventions to improve clinical reasoning
• The Hypothesis-Driven Physical Examination
• A novel bedside cardiopulmonary physical diagnosis curriculum for internal medicine postgraduate training