Hybrid Physical Examination: Integrating Peer Feedback with Standardized Patient Encounters

Physical examination skills are fundamental to clinical practice, yet traditional training models often fail to integrate structured peer feedback with standardized patient (SP) encounters, limiting development of both clinical and feedback competencies.

This study evaluated a novel hybrid physical examination training model that integrates structured peer feedback with SP encounters across multiple organ systems, hypothesizing that this approach would improve students' physical examination knowledge, confidence, and feedback literacy.

This prospective educational intervention involved a cohort of 175 preclinical students at a U.S. medical school across four systems (musculoskeletal, cardiovascular, pulmonary, gastrointestinal) during 2025. Each session comprised facilitator-led peer practice using standardized checklists, followed by SP encounters where students rotated through examiner and observer roles, providing structured oral and written feedback. Pre- and post-session surveys assessed confidence and perceptions using a 5-point Likert scale, while ungraded knowledge tests measured skill acquisition. Data were analyzed using Mann-Whitney U tests.

Knowledge scores improved significantly in musculoskeletal (MSK) (4.02 to 4.28, p = 0.048), cardiovascular (CV) (3.77 to 4.18, p = 0.018), and gastrointestinal (GI) (3.47 to 4.05, p = 0.028) sessions. Confidence in performing physical examinations increased significantly across all systems (all p < 0.001). Perceptions of SP educational value improved in MSK (4.26 to 4.69, p < 0.001), CV (4.41 to 4.71, p = 0.009), and GI (4.29 to 4.95, p < 0.001) sessions. Ratings for both giving and receiving feedback improved significantly in most sessions. Pulmonary session results showed confidence gains but non-significant changes in other measures, likely due to reduced response rates.

The hybrid model effectively enhanced physical examination knowledge, confidence, and feedback literacy across multiple organ systems. Integration of structured peer feedback with SP-based practice prepares students for collaborative and feedback-rich clinical environments. This model shows promise for strengthening skill acquisition and feedback competence in undergraduate medical education.