# The art of the clinical examination is still relevant in internal medicine at teaching hospitals in South Africa

## TL;DR

This paper argues that clinical examination remains essential in internal medicine training in South African hospitals despite increased access to advanced diagnostic tools.

## Contribution

The paper highlights the risk of declining bedside skills in internal medicine due to overreliance on investigations and advocates for preserving clinical examination in training.

## Key findings

- Peripheral hospitals in Cape Town have improved diagnostic efficiency through accessible investigations.
- Tertiary hospitals face reduced emphasis on clinical skills due to overburdened admissions and prior investigations.
- Clinical examination is vital in South Africa's resource-limited setting for training and diagnosis.

## Abstract

Clinical examination has long been central to diagnostic reasoning and to cultivating core professional attributes in internal medicine training; however, the relevance of clinical examination has been increasingly questioned in an era in which rapid access to specialised investigations is expanding. In the Eastern Metropole of Cape Town, the ‘decentralisation’ of specialised investigations, particularly radiological imaging and point-of-care ultrasound, has made these tools readily accessible at peripheral hospitals. While diagnostic efficiency has improved at peripheral centres, this improvement has occurred alongside a reduced emphasis on fundamental bedside skills among internal medicine registrars at the tertiary level. At our tertiary centre, the overburdened internal medicine admissions area leaves little time for detailed history taking or comprehensive physical examination. Consequently, investigations performed at referring centres often precede bedside assessment at our centre. This trend risks eroding the core competencies within internal medicine training, including diagnostic reasoning, observational proficiency and elements of the hidden curriculum such as communication, rapport-building and professionalism. In South Africa’s resource-constrained environment, in which clinicians often confront advanced disease and complex pathology, the clinical examination remains indispensable. Training programmes should reaffirm the vital role of clinical examination, ensuring that registrars in internal medicine maintain mastery of bedside assessment, rather than relying on special investigations. The art of clinical examination remains fundamental to good medical practice and should be actively preserved within teaching hospitals.