Teaching and learning clinical perception.

A central task in clinical teaching is organization of the students' experience in clinical perception--the ability to observe, to recognize, to discriminate and to interpret clinical evidence. We cannot teach sensory perceptual experience. Students must experience the clinical phenomena for themselves. But we can ensure that what the student experiences is most likely to be turned into clinical learning. This paper dissects the learning task in order to derive plans for teaching clinical perception. A major purpose is to encourage closer study of physical examination, which has largely been upstaged by investigations. Students learn inductively from their experiences of examining patients, cumulating a 'clinical memory' of images of patients with diseases. Reflection on that experience with the clinical teacher translates the sensory evidence into words. Teachers link the clinical observations of 'disease in patients' with previously learned images of 'diseases in organs', to ensure that clinical features and underlying basic science knowledge are clearly integrated. Perception is an active process, not a passive reception of observational data. Learning and teaching clinical perception uses both the student's direct 'sense' experiences and the teacher's guidance in 'making sense' of them.