Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program
Introduction The head-to-toe approach to teaching the physical examination (PE) focuses on technique and performing a comprehensive PE whereas core + clusters and hypothesis-driven PE (HDPE) approaches integrate clinical reasoning into performing a focused PE. These approaches can be implemented in...
| Main Authors: | , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Association of American Medical Colleges
2020-11-01
|
| Series: | MedEdPORTAL |
| Subjects: | |
| Online Access: | http://www.mededportal.org/doi/10.15766/mep_2374-8265.11043 |
| _version_ | 1818398105451626496 |
|---|---|
| author | Julia Kelly Sandra K. Oza Richard Feinn Todd Cassese |
| author_facet | Julia Kelly Sandra K. Oza Richard Feinn Todd Cassese |
| author_sort | Julia Kelly |
| collection | DOAJ |
| description | Introduction The head-to-toe approach to teaching the physical examination (PE) focuses on technique and performing a comprehensive PE whereas core + clusters and hypothesis-driven PE (HDPE) approaches integrate clinical reasoning into performing a focused PE. These approaches can be implemented in a developmental sequence. We report the implementation and evaluation of an HDPE educational session. Methods We designed a 3-hour HDPE session as part of a transition to clerkship program. For each of five clinical vignettes, rising third-year students worked in pairs and then in small groups to generate a differential diagnosis and determine relevant PE maneuvers. Students next performed these maneuvers on peers with facilitator observation and feedback. Students completed postsession surveys on their retrospective pre- and postsession knowledge and confidence, as well as their satisfaction with the session. We completed quantitative and qualitative analyses on survey data. Results One hundred ninety-two students participated, and 140 (73%) completed the survey. Students were significantly more likely to report feeling confident generating a differential diagnosis and using it to select PE maneuvers for common complaints postsession. Over 80% of respondents felt the session improved critical thinking about patient presentations and would help them in clerkships. Discussion Our session increased student confidence in the progression to performing an HDPE just prior to the start of clerkships. The session is feasible and straightforward to implement. It requires a large number of faculty to facilitate, but the breadth of cases used allows inclusion of faculty from all fields. |
| first_indexed | 2024-12-14T06:59:30Z |
| format | Article |
| id | doaj.art-0ea59bd1d4194bffbf3356d61114e0ec |
| institution | Directory Open Access Journal |
| issn | 2374-8265 |
| language | English |
| last_indexed | 2024-12-14T06:59:30Z |
| publishDate | 2020-11-01 |
| publisher | Association of American Medical Colleges |
| record_format | Article |
| series | MedEdPORTAL |
| spelling | doaj.art-0ea59bd1d4194bffbf3356d61114e0ec2022-12-21T23:12:28ZengAssociation of American Medical CollegesMedEdPORTAL2374-82652020-11-011610.15766/mep_2374-8265.11043Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship ProgramJulia Kelly0Sandra K. Oza1Richard Feinn2Todd Cassese3Resident Physician, Department of Medicine, Tufts Medical CenterAssociate Professor, Department of Medicine, Albert Einstein College of Medicine; Co-Director, Introduction to Clinical Medicine and Transition to Clerkship, Albert Einstein College of MedicineAssociate Professor, Department of Medical Sciences, Frank H. Netter MD School of Medicine at Quinnipiac UniversityAssociate Professor, Department of Medicine, Albert Einstein College of Medicine; Assistant Dean for Clinical Sciences Education, Albert Einstein College of MedicineIntroduction The head-to-toe approach to teaching the physical examination (PE) focuses on technique and performing a comprehensive PE whereas core + clusters and hypothesis-driven PE (HDPE) approaches integrate clinical reasoning into performing a focused PE. These approaches can be implemented in a developmental sequence. We report the implementation and evaluation of an HDPE educational session. Methods We designed a 3-hour HDPE session as part of a transition to clerkship program. For each of five clinical vignettes, rising third-year students worked in pairs and then in small groups to generate a differential diagnosis and determine relevant PE maneuvers. Students next performed these maneuvers on peers with facilitator observation and feedback. Students completed postsession surveys on their retrospective pre- and postsession knowledge and confidence, as well as their satisfaction with the session. We completed quantitative and qualitative analyses on survey data. Results One hundred ninety-two students participated, and 140 (73%) completed the survey. Students were significantly more likely to report feeling confident generating a differential diagnosis and using it to select PE maneuvers for common complaints postsession. Over 80% of respondents felt the session improved critical thinking about patient presentations and would help them in clerkships. Discussion Our session increased student confidence in the progression to performing an HDPE just prior to the start of clerkships. The session is feasible and straightforward to implement. It requires a large number of faculty to facilitate, but the breadth of cases used allows inclusion of faculty from all fields.http://www.mededportal.org/doi/10.15766/mep_2374-8265.11043Clinical ReasoningPhysical ExaminationHypothesis-Driven Physical ExaminationClinical SkillsClinical Reasoning/Diagnostic ReasoningClinical/Procedural Skills Training |
| spellingShingle | Julia Kelly Sandra K. Oza Richard Feinn Todd Cassese Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program MedEdPORTAL Clinical Reasoning Physical Examination Hypothesis-Driven Physical Examination Clinical Skills Clinical Reasoning/Diagnostic Reasoning Clinical/Procedural Skills Training |
| title | Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program |
| title_full | Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program |
| title_fullStr | Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program |
| title_full_unstemmed | Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program |
| title_short | Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program |
| title_sort | implementation of a hypothesis driven physical exam session in a transition to clerkship program |
| topic | Clinical Reasoning Physical Examination Hypothesis-Driven Physical Examination Clinical Skills Clinical Reasoning/Diagnostic Reasoning Clinical/Procedural Skills Training |
| url | http://www.mededportal.org/doi/10.15766/mep_2374-8265.11043 |
| work_keys_str_mv | AT juliakelly implementationofahypothesisdrivenphysicalexamsessioninatransitiontoclerkshipprogram AT sandrakoza implementationofahypothesisdrivenphysicalexamsessioninatransitiontoclerkshipprogram AT richardfeinn implementationofahypothesisdrivenphysicalexamsessioninatransitiontoclerkshipprogram AT toddcassese implementationofahypothesisdrivenphysicalexamsessioninatransitiontoclerkshipprogram |