About Stanford Medicine 25
The Stanford Medicine 25 consists of hands-on sessions and online content to teach the bedside physical exam to students, residents and faculty and promote the culture of bedside medicine.
Why the Stanford Medicine 25?
We recognize that there is little emphasis on these physical exam skills in the 3rd and 4th years of medical school or in residency.
In the absence of a high-stakes clinical bedside final exam (as opposed to a high-stakes multiple choice exam), there is little impetus for people to learn and master bedside skills.
Does it matter? It does to us.
The truth is, someone may be board certified in internal medicine or another specialty and no one has really ascertained that their technique in doing an ankle reflex enables them to accurately say a reflex is truly absent — take note, you would be surprised how most 'absent' reflexes become 'present' when you learn good technique.
More and more health care professionals are to do more with less. The number of stories about healthcare providers ordering unnecessary labs, images and other expensive tests are growing. We believe that caring for the patient starts at the bedside with observing, examining and connecting with our patients. This is what the Stanford Medicine 25 teaches and promotes.
In observing students and residents perform physical diagnosis maneuvers at the bedside, we observe that though they know the theory, their technique may prevent them from eliciting the sign reliably.
We find a real hunger among our residents in internal medicine to sharpen their skills at the bedside.
Many diseases (almost all of dermatology for instance) are diagnosed by bedside exam. In neurology, for example, even if the CT and MRI reveals a lot to you, only your exam can tell you what the functional consequence is in terms of motor or sensory loss or cognitive deficit.
For evidence-based medicine fans, a cautionary note here: we are not trying to prove anything, but we do want to be sure that when people write in the chart "reflexes intact" or "cranial nerves intact" or "S1 and S2 heard, no murmurs, rubs or gallops" that it is not a form of fiction, but represents an accurate observation.
The Stanford Medicine 25 Team
The Stanford Medicine 25 team is the core group of physicians, faculty and students led by Dr. Abraham Verghese. Each member plays various roles with the Stanford Medicine 25 team and our Program for Bedside Medicine. The group hosts this website and an annual Stanford 25 Skills Symposium for physicians.
Abraham Verghese, MD, MACP is the Linda R. Meier and Joan F. Lane Provostial Professor and Vice Chair for the Theory & Practice of Medicine, as well as the Internal Medicine Clerkship Director at Stanford University School of Medicine. His research interests lie in development of clinical skills and the bedside exam, both in its technical aspects, but also in the importance of the ritual and what is conveyed by the physician's presence and technique at the bedside. Dr. Verghese is also an international award winning author.
John Kugler, MD is an Assistant Professor of Medicine, Stanford School of Medicine, Department of Internal Medicine. His is the Internal Medicine Student Clerkship/Sub-internship Co-Director and personally runs the ultrasound course for Stanford residents. His research interests lie in the bedside exam and the use of technology in improving medical education and plays a big role in the education of Stanford Medical Students.
Errol Ozdalga, MD is a Stanford Internal Medicine Assistant Professor of Medicine. He is The Director of the Stanford Medicine 25 which oversees this website, all online presence and our regular Stanford 25 sessions of Stanford residents. He is also a hospitalist, Director of Communications for the Department of Medicine and helps run the 3rd year medical student internal medicine clerkship. He runs this website, Facebook page and our Twitter account. His additional interests involve the use of technology and social media towards better medical education and patient care.
Andrew Elder, MD was educated at Edinburgh University and graduated BSc in 1979 and MBChB in 1982. First appointed as an NHS consultant in 1993 he is currently Consultant Physician in Acute Medicine for Older People at the Western General Hospital in Edinburgh and an Honorary Professor at Edinburgh Medical School.
Andrew has held a number of positions in undergraduate and postgraduate medical teaching and assessment at local and national levels, and is currently Medical Director of MRCP(UK), which provides postgraduate examinations in internal medicine and its specialties to 25,000 candidates per annum globally. Previously Chair of the Clinical Examining Board for the MRCP(UK) PACES examination - the largest international postgraduate clinical skills assessment in the world - he has personally taught or assessed bedside clinical skills in twenty countries.
He is an advocate for the need to ensure that the core bedside skills of communication, physical examination and clinical judgement remain central to the education and training of young doctors. Since 2013 he has worked as part of the S tanford 25 Bedside Medicine Programme, and was the Shenson Visiting Professor in 2015.
Sonoo Thadaney is Director of the Program in Bedside Medicine. Sonoo's career has included academic program management and student affairs; teaching and mentoring; high tech marketing, management, business development and sales; mediation; executive/leadership coaching, and filmmaking. In each career she works with brilliant minds as they focus on research, teaching, innovation and she helps translate their work for wider and deeper impact. She teaches conflict and decision coaching at Stanford. Sonoo academic work has been in Psychology, Sociology, Communications and an MBA.
Maja Artanti, MD is a Clinical Assistant Professor and primary care doctor at Stanford. She is involved in resident education in the clinic and a member of the Stanford 25 team that is focusing on content creation, video direction and Stanford 25 conferences, such as our presense at SGIM. She is serving as faculty for the Stanford 25 Skills Symposium.
Lars Osterberg, MD is Co-Medical Director of Arbor Free Clinic, Director of the hypertension clinic, a past Chief of Internal Medicine at the VA, Palo Alto and current Director of the Educators-4-CARE. He had significant interests in medial education and caring for the homeless and plays a number of roles supporting the work of the Stanford Medicine 25. He is serving as faculty for the Stanford 25 Skills Symposium.
Junaid Zaman, MD, obtained his medical degree from University of Oxford. He is trained in cardiology and currently at Stanford as a Fulbright Scholar, doing work in heart rhythm disorders, working towards his PhD. He has a proven history of teaching at the bedside and has joined our team in support of our work through mulitple way including creating contect for the Stanford 25 blog, leading Stanford 25 sessions and serving as faculty for the Stanford 25 Skills Symposium.
Our premedical students play a tremendous role in many of the Stanford 25 organizing sessions, contacting patients and helping create our skills symposium:
- Nicole Jeffery
- Baffour Kyerematen
- Wendy Zhang
We also extend a special thanks to the following contributors:
- Nancy D'Amico, a member of our Stanford 25 team
- Blake Charlton, MD for his years of contribution to the Stanford Medicine 25 and earlier versions of this website
- Benjamin Seligman who helped with some of the content on this website
And finally, our Stanford chief residents who help organize and conduct our Stanford Medicine 25 sessions.
The Stanford Medicine 25 does NOT mean we think there are only "25" exam topics that should be taught. We simply wanted to start somewhere and we want you to do the same. Whether you're starting with 25, 5 or even just 1 exam topic... we want you to start somewhere and be confident in whatever bedside exam you choose.
We could have easily made this the Stanford 50 or Stanford 200. Yes, we could have easily substituted a different 25 things instead of the ones we chose. If we left out your favorite organ or test, please don't take it personally. Please note we are continually updating and adding new content. While we started with "25", we are adding many more! While we'll always be called "25", we'll have many more topics on this site!
We are thrilled to find so many online physical exam resources and have linked to those we find the most useful. We are also dedicated to providing proper acknowledgment and credit to all external information and images. If you are aware of a useful online resource, or spot an area where we might provide acknowledgment more clearly, please let us know.
Why is your Logo an Apple Tree?
The Stanford Medicine 25 apple tree is a symbol for one of the main purposes that we teach the bedside exam. While some exam techniques can be more complex than others, much of what we teach is easily learned and can be tremendously valuable. In many cases, the exam finding is easy to detect. Too often, a diagnosis is missed and care is delayed not because the answer was too hard to find, it simply wasn't looked for! We believe much of medical error can be avoided if we take the time to lay hands on the patient and find that clue or obvious exam sign. We teach to always exam and make sure to never miss the low hanging fruit!
Visit this page to watch a video of Dr. Verghese talk about a missed diagnosis of breast cancer in a patient where the diagnosis could have been easily made with an exam.
Learn More About Our Team
- The Journal of American Medical Association:
Evolutionary Pressures on the Electronic Health Record
- Journal of the Royal Colleage of Physicians of Edinburgh:
Bedside Matters - putting the patient at the centre of teaching and learning
- The Journal of American Medical Association - Cardiology:
I Carry Your Heart
- The American Journal of Medicine:
Inadequacies of Physical Examination as a Cause of Medical Errors and Adverse Events: A Collection of Vignettes
- The Journal of American Medical Association (JAMA):
Clinical Education and the Electronic Health Record: The Flipped Patient
- The Journal of American Medical Association (JAMA):
Improving communication with patients: learning by doing.
- The Journal of American Medical Association (JAMA):
The Road Back to the Bedside
- Annals of Internal Medicine:
The bedside evaluation: ritual and reason.
- Editorial in the British Medical Journal:
In Praise of the Physical Examination
- Perspective in the New England Medical Journal:
Patient as Icon, Icon as Patient
- Editorial in the Journal of General Internal Medicine:
The Physical Exam and Other Forms of Fiction
- Essay in Health Affairs:
A Touch of Sense
- New York Times Article:
Physician Revives a Dying Art
- NPR article:
The Fading Art Of The Physical Exam
- Dr. Verghese on NPR's Talk of the Nation:
One Doctor's Mission To Revive The Humble Physical