 PHYSICAL EXAMINATION OF THE NEWBORN
Produced by Paul Colditz, University of Queensland
Review by Eve Colson MD
Details about the newborn physical examination can now be found in the CD rom multimedia format. The CD rom program of Physical Examination of the Newborn was developed at the University of Queensland, Brisbane, Australia, under the direction of Professor Paul Colditz as a combined effort of the Educational Media Services, Educational Development Institute and the Perinatal Health Research Centre. It was designed to teach students and caregivers about how to complete a physical examination of a newborn baby, recognize common physical findings, learn about the presentation of some neonatal diseases, and choose some appropriate management options.
To reach these goals, the interactive program allows users to view a full physical examination of the newborn and to perform a virtual physical examination. The producers of the program also provided an encyclopedia of terminology that allows the user to review unfamiliar terms and learn more extensively about specific physical findings in the newborn.
When choosing to watch the physical examination, the user will see a full videotape with accompanying audio recording of the examination of a healthy full-term newborn. While viewing the video, it is possible to stop, rewind, and fast forward to specific parts. During the opening segments, viewers are reminded about important aspects of the history that are pertinent to the care of the infant and should be obtained before starting the examination. A systematic review of the examination is then covered, during which terminology is listed to the side of the screen. At any time the viewer can stop the video to click on the term to get an immediate definition.
In addition to watching the physical examination, the user can elect to conduct an examination on a virtual baby. Several infants are described and the user can click on different regions for examination. In one case, for example, if the user clicks on the eyes, the picture of a baby with purulent eye discharge will appear. The user will then have the option to choose the diagnosis, and the answer and explanation then appear for review.
The encyclopedia that is also offered as one of the options on this CD rom is a comprehensive listing of terms used to describe physical findings in the newborn. A picture of the physical finding and a written explanation accompanies each term. By clicking on body regions, the user can view common physical findings, such as lanugo and milia, as well as other findings less commonly seen. The virtual baby can also be rotated to show both ventral and dorsal views.
Overall, this CD rom is well done and could prove helpful, especially to students learning about the newborn physical examination for the first time and to their teachers. It is unusual to find such an extensive collection of pictures of newborn physical findings in one place that are also accompanied by clear explanations and definitions. In our well newborn program at the Yale University School of Medicine, we have used this CD rom as a supplement to the hands-on teaching that occurs during the rotations through the well-newborn nursery. Both residents and medical students found it a good adjunct to their learning. Since they have short rotations, the students and residents thought it was particularly useful to see pictures accompanied by explanations of physical findings they had not seen while on the rotation but might encounter when they are practising on their own.
In general, this CD rom is 'user friendly', especially when viewing the physical examination and accessing the encyclopaedia. We recommend that our students approach the physical examination slightly differently from the approach demonstrated in the video. Whereas the examiner in the video begins with the arms followed by the infant's head, we recommend that residents and students begin with the cardiac examination. Beginning with the heart in a quiet baby will minimize the risk of not being able to complete the examination if the infant begins to cry. In addition, working through the interactive physical examinations can be somewhat frustrating because of the lack of ability to move back and forth in the CD rom and choose which exam is to be completed. Once starting the initial examination, the user must move through the entire examination before moving on to the next; it is also not possible to skip the initial one and move on to the next.
Despite these limitations, this CD rom is a useful addition to the currently available methods for teaching about the newborn physical examination.
Eve Colson MD
Director, Well Newborn Nursery & Asst Professor of Paediatrics
Yale University School of Medicine & Yale-New Haven Hospital
New Haven, Connecticut 06504 USA
Reprinted, with editor's permission, from Birth: Issues in Perinatal Care 2000;27(4):293, published by Blackwell Science. www.blackwellscience.com/bir
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