IntroductionAbout the Guide

Introduction

Welcome to Clinical Skills: The McMaster pre-clerkship clinical skills curriculum focuses on practicing core skills involved in patient care, including history-taking, physical exam and patient-centered communication skills that students build on in later stages of training. The curriculum is sequenced to mirror medical foundation (MF) tutorials where possible. Horizontal integration with professional competencies includes a focus on evidence-based diagnosis, clinical decision-making, and social accountability. Clinical decision-making and healthcare team communication skills are introduced in later stages of the curriculum.

About the McMaster Clinical Skills Guide: The guide is a core curricular resource to support learning of clinical exams, integration of evidence-based practice, and patient-centered communication skills. Features we hope you will find helpful include:

1. History and Patient-Centered Communication Skills: Chapter 1 outlines an example of how to structure a history that is replicated in each chapter, along with core patient-centred communication skills structured according to the Kalamazoo Framework. In addition Appendix 1 and Appendix 2 outline basic communication skills with patients and healthcare teams.
2. Structured Physical Exams: Each physical exam maneuver is outlined in a say-do-report methodology showing how to verbalize and perform each maneuver in a clinical encounter. After each maneuver, “Why Check” outlines what clinical diagnosis questions a given physical exam test can help to answer.
3. Evidence-Based Diagnosis Integration:

   • a. Primer on Evidence-Based Practice: Chapter 2 provides a brief overview of key concepts relevant to clinical skills, with a focus on Evidence-Based Diagnosis.

   • b. Likelihood Ratios: 136 evidence-based diagnosis clinical questions are integrated as tables of likelihood ratios at the end of each chapter. These are colour-coded based on the Simplified Approximation Method to Apply Likelihood Ratios for a pre-test probability between 10-90% (outside of this range, the simplified method is not valid). Red indicates a decrease in post-test probability, Green indicates an increase in post-test probability, and Grey indicates no change in post-test probability. Deeper shades of Red and Green indicate greater changes in post-test probability (See Table to Right). Likelihood Ratios are integrated in the Why Check section for a given physical exam maneuver where pertinent.

     LR	Approx. Change in Probability
     0.1	-45% (LR ≤ 0.1 in guide)
     0.2	-30% (0.5 > LR > 0.1 in guide)
     0.5	-15% (1 > LR ≥ 0.5 in guide)
     1	0 (95% CI range crosses 1 in guide)
     2	15% (1 < LR ≤ 5 in guide)
     5	30% (5 < LR < 10 in guide)
     10	45% (LR ≥ 10 in guide)

   • c. Choosing Wisely Canada Recommendations and Relevant Clinical Decision Rules: Integrated in each chapter where available.

4. Social Accountability Integration:
   • a. Inclusive social history screening questions for equity-deserving populations found in Chapter 1, modeled on IF-IT-HELPS framework.
   • b. Equity-Deserving Populations Primer in Chapter 3 serves as a common vocabulary to promote engaging, respectful discussion.
   • c. Modifications to History and Physical exams for equity-deserving populations are integrated for select maneuvers.
5. Record of Your Learning: Appendix 5 includes a checklist of physical exam maneuvers by chapter as a self-assessment tool to identify opportunities for further practice, direct observation and feedback.
6. Quick Reference: The guide is a single, cohesive resource, with a network of hyperlinks and index for a quick search in clinical settings.

Stethopedia Integration: Stethopedia, led by McMaster medical students and residents, creates open-access clinical skills educational videos. These videos complement the McMaster Clinical Skills Guide and are developed independently from the McMaster UGME program. In each weekly session page where a new physical exam is introduced, Stethopedia videos are embedded as helpful resources. If you are interested in getting involved with Stethopedia, please email stethopedia@gmail.com.

AFMC National Clinical Skills Curriculum: The guide aligns with AFMC National Clinical Skills Expectations. In each chapter, expectations for specific tests are found in parentheses with the following format:

[Pre-Clerkship Expectation Level, Clerkship Expectation Level], with levels as follows:

• Level 1: Describe the physical sign or maneuver but not elicit it
• Level 2: Perform the maneuver and explain the rationale for the test. Elicit the physical sign.
• Level 3: Perform the maneuver or recognize physical sign and interpret findings in terms of pathophysiology
• Level 4: Perform the maneuver or recognize physical sign and may know the evidence justifying the use of the test; interpret findings and generate a differential diagnosis based on the findings.
• Procedural Clinical Skills are described in Appendix 4 with associated AFMC expectations listed.

Acknowledgements: The 6th edition transitions the guide to a focused, online curricular resource, including weekly session guides and resources housed in a dedicated Medportal session (www.medportal.ca/ug/clinical-skills), and beginning Fall 2026, transitioning to an electronic McMaster Clinical Skills Guide platform (https://clinicalskillsguide.medportal.ca/) – each requiring Medportal login. It is exciting to see the project continue to grow through student-driven initiative. Thank you to my wife Katie for her love and support; to our daughter, Maddie, for being open to hearing this book read to her for story-time; to our cats who wander across the keyboard to “help”, and to my parents for supporting me always.

Jeffrey McCarthy MD CCFP(PC) (he/him/his)
Chair, UGME Clinical Skills and OSCE Committees
Assistant Clinical Professor – Division of Palliative Care, Department of Family Medicine, McMaster University

Past Editors