One of the most fascinating components of medicine is the art of patient assessment. Having the skills and knowledge to lay your hands on a fellow human and assess their body for physiologic abnormalities is a vital skill to being a medical provider. The PA profession prides itself on having keen physical assessment skills and taking time to thoroughly assess patients in order not to miss an important diagnosis. The Duke PA program ensures that we develop these skills, through a series of courses called Patient Assessment and Counseling (PAC). Every Friday we have a patient assessment and counseling session where we are divided into small groups and practice various components of the physical exam. This has been an incredible opportunity to hone assessment skills, and a time I look forward to every week! At the end of the semester we have an opportunity to demonstrate a complete physical exam. It is truly a gratifying process to be able to assess a patient from head to toe in under forty-five minutes.
One component of the physical exam that we spent extra time on was assessing heart and lung sounds. To learn this skill we utilized the Harvey cardiopulmonary simulator. Harvey is a life-like mannequin who can produce heart and lung sounds consistent with various conditions. To introduce us to Harvey and begin delving into the exciting study of these physiologic and pathologic sounds our small group headed down to one of the two Harvey simulation rooms. Once inside each student grabs an electronic stethoscope which has a digital sound receiver. The instructor has a digital stethoscope which when applied to Harvey’s chest transmits the sounds of his heart and lungs to both her stethoscope but also all of the student’s stethoscopes. This allows everyone in the room to hear the sounds simultaneously. There are literally hundreds of combinations of sounds that Harvey can produce that are consistent with various pathophysiologies. Our instructor also diagramed on the board the sounds we were hearing and the phase of the cardiac or respiratory cycle we were hearing them in. We also tapped out the rhythm of the sounds with our fingers, much like drumming the beat to a song. We found this very helpful because it stimulated all of our learning styles: auditory, visual, and tactile. This is just one example of the phenomenal instructional methods that faculty members of the Duke PA program utilize to deliver content. The Harvey simulator is a wonderful tool that is available to us at any time to review these sounds. Several second year students found it helpful to spend some time visiting Harvey prior to internal medicine or cardiology rotations to brush up on skills they learned in the first semester of PA school. I feel so fortunate to be in a program that utilizes technology like the Harvey simulator to help deliver content. Moving forward I feel much more confident in assessing cardiac and pulmonary sounds thanks to great instruction from the PA faculty and our dear friend Harvey!