Examination of the child combines science with art; developing competence in paediatric examination requires both knowledge of the correct technique and hours of hard work and practise. Lack of either will make the examination technique incomplete or inadequate. Perhaps the greatest difficulty an inexperienced doctor faces is to gain the confidence and trust of the child and their carers, while creating an impression of grounded self-confidence. In the examination, one should carry oneself well. This means you should be a good listener, be interested, cheerful, respectful, warm, caring, friendly, empathic, competent, and diplomatic. It is imperative to listen actively to the child and their carers and be as natural as possible—just as you would be with your friend’s child or indeed your own. The examination begins the moment you enter the room. It is essential to understand that the general approach to the physical examination of the child will be different from that of an adult and will vary according to the age of the child. As the child’s cooperation cannot be guarantied, you should remember that it is impossible always to use a set protocol while examining the child. We have listed the essential steps of examination in a particular order so that all areas are covered, but the candidate needs to adapt the examination sequence according to the needs of the child and the situation. As a general rule, anything that will inevitably be uncomfortable or unpleasant for the child (e.g. otoscopy or rectal examination) should be the ‘last act’ of the examination. A common mistake made by nervous candidates is to talk too fast; this is a trait that will always be more exaggerated under the stress of the exam. Pausing at the end of each sentence is an effective way of slowing down. Ensuring that each word is pronounced completely will also lessen the pace of your speech. Talking slowly and clearly with a smile on your face will help to hide nervousness. In this book and the accompanying videos, examinations are performed in a systematic manner. These steps provide a useful framework. Although there can be some flexibility, following the steps listed here will improve your technique.
A New Physical Examination Technique for Evaluating Valgus Knee Deformity
