Implementation of a Hypothesis-Driven Physical Exam Session in a Transition to Clerkship Program

Area of Science:

• Medical Education
• Clinical Skills Training
• Diagnostic Reasoning

Background:

• Traditional head-to-toe physical examination (PE) teaching prioritizes technique.
• Alternative approaches like hypothesis-driven PE (HDPE) integrate clinical reasoning for focused examinations.
• These methods can be implemented sequentially in medical training.

Purpose of the Study:

• To implement and evaluate a hypothesis-driven physical examination (HDPE) educational session for medical students.
• To assess the impact of the HDPE session on students' diagnostic reasoning and confidence.
• To determine the feasibility and effectiveness of the HDPE session in a transition to clerkship program.

Main Methods:

• A 3-hour HDPE session was designed using clinical vignettes for third-year medical students.
• Students worked in pairs and groups to generate differential diagnoses and select relevant PE maneuvers.
• Facilitator observation, feedback, and post-session surveys were used for evaluation.

Main Results:

• 140 out of 192 students completed the survey (73% response rate).
• Post-session, students reported significantly higher confidence in generating differential diagnoses and selecting PE maneuvers.
• Over 80% of students felt the session improved critical thinking and would aid them in clerkships.

Conclusions:

• The HDPE educational session effectively increased student confidence in performing focused physical examinations prior to clerkships.
• The session is feasible and straightforward to implement, requiring faculty from diverse specialties.
• This approach enhances clinical reasoning skills essential for medical practice.