Core + Clusters: A Practical Clinical Reasoning-Based Toolkit for Revitalizing Physical Diagnosis Training

The way we teach physical diagnosis needs to be revitalized. Medical students now see patients in their first year, and the traditional head-to-toe physical exam (HTTE) can be overwhelming with its over 100 manoeuvres and does not give learners physical exam readiness for early clinical work. We have developed and implemented Core + Clusters (C + C). C + C begins with a streamlined Core Exam, with approximately 40 manoeuvres, that prepares learners for early clinical experiences. Diagnostic Clusters, the second component of C + C, are sets of history-taking questions and physical examination manoeuvres critical to discriminating among diagnoses in common clinical presentations. They build on prior education models by combining hypothesis-driven history-taking with hypothesis-driven physical examination to better resemble clinical practice. The C + C model is feasible, requires resources similar to those used in the HTTE curriculum and is flexible enough to adapt to the curricula of diverse institutions. In this paper we offer a C + C toolkit which describes the C + C components, gives examples of curricular implementation and shares lessons we have learned from over 10 years of experience with C + C.