The Stanford 25

An Initiative to Revive the Culture of Bedside Medicine





“The Map is not the Territory.”

—Alfred Korzybski

Welcome to the Stanford 25 website. Remember, this site is NOT the Stanford 25; it is only  a map to a territory, one that must be explored in person!  The Stanford 25 consists of hands-on sessions in small groupsyou can’t substitute for that, and we don’t try to. This site simply provides a place where our students and residents can go to remind themselves of what they learned, or are about to learn in a hands-on session.

Why the Stanford 25?

  • We recognized that after a med school physical diagnosis course, there is little emphasis on these skills in the 3rd and 4th years of medical school or in an internal medicine 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 skillstruth is, you can be board certified in internal medicine and no one has really ascertained that your technique in doing an ankle reflex allows you to accurately say a reflex is truly absent. (You will be surprised how most ‘absent’ reflexes become ‘present’ when you learn good technique.)  Does it matter?  It does to us.
  • 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 m or g” that it is not a form of fiction, but represents an accurate observation.

What are the goals of a Stanford 25 hands-on teaching session?

  • Actually explore the territory, not just study the map.
  • Demonstrate one or more of the 25 technique dependent physical diagnosis maneuvers, then have the residents perform, demonstrate, perfect and show us how they teach.
  • Add to the repertoire of bedside skills a resident has so that they feel at home and have plenty to observe, demonstrate, and teach.
  • Create an appreciation for technique and thereby inspire them to add more skills to their repertoire.
  • Create a culture (yes, it’s happening here) where we collect physical signs, alert others to patients with findings that are instructive, celebrate simple diagnoses that came from listening to a history well, and looking for and finding a critical physical finding.

Before you send us letters asking why X or Y was not included in our Stanford 25 (and we have received many such letters) please remember:

  • This is not a David Letterman TOP 25.
  • Instead, it simply represents 25 things we wanted to focus on. We could have easily made this the Stanford 50 or Stanford 200.
  • Yes, we could easily have substituted a different 25 things for the ones we chose.
  • If we left out your favorite organ or test, please don’t take it personally.

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 on our contact page.

This website was not designed by professionals. Neither were our videos created by professionals; the audio is not ideal (we are working to redo some of them). If this site appears more folksy than slick  it is because it is only the map is not the territory. We would like to spend our time in hands-on sessions and have less time to polish the website. We hope this site will inspire you to leave the computer and explore the territory.

Publications from the Stanford 25 Team:

A Partial List of Publications Related to Bedside Medicine & the Physical Exam:

The Stanford 25 Team:

  • Abraham Verghese, MD, MACP is the Senior Associate Chair for the Theory & Practice of Medicine, the Internal Medicine Residency Program Director, 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.
  • John Kugler, MD is an Assistant Professor of Medicine, Stanford School of Medicine, Department of Internal Medicine. His research interests lie in the bedside exam and the use of technology in improving medical education.
  • Karim Sallam, MD is currently first year cardiology fellow in Stanford’s program in cardiovascular medicine. As chief resident for Stanford’s Department of Internal Medicine, Doctor Sallam oversaw the formative steps of the Stanford 25’s website development. His research interests include clinical education and molecular signaling in cardiomyogenesis.
  • Errol Ozdalga, MD is currently in his final year of residency training in the Stanford University Internal Medicine Program. His interests involve an emphasis in the technique of bedside medicine and providing students and physicians in training support in this area.
  • Blake Charlton, BA is a medical student at Stanford, a recipient of the Stanford Medical Scholars Research Fellowship, and an appointed Research Assistant for the Department of Internal Medicine. His research interests lie in bedside diagnosis, medical humanities, and medical education.
  • Amar Trivedi, BA  is a fourth-year medical student at Stanford.  He is applying in Internal Medicine with an interest in the philosophy of medicine, bioethics, and using new technology at the bedside.
  • Benjamin Seligman, BA, is a medical student at Stanford and a former Fulbright scholar.  His research interests are in clinical research and the treatment and prevention of chronic diseases in developing countries.
  • Special thanks to our chief residents Katherine Cheung MD, Ellen Eaton MD, Victoria Kelly MD, Chanu Rhee MD, & Christopher Woo MD for helping to organize and teach the initiative in our program.

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A Partial List


Written by stanford25admin

June 7, 2010 at 1:32 pm