A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence

Abstract

The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner.

Emphasizing High Value, Cost-Effective Care in Physical Examination Instruction – A Qualitative Content Analysis of Interviews with Expert Educators

“…Consistent with the "core and clusters' and hypothesis-driven approaches that have recently appeared in the literature, [Yudkowsky et al, 2009;Gowda et al, 2014b] our experts advocated for more pragmatic curricula that prioritized clinical reasoning and hypothesis testing. They also called for longitudinal development of skills rather than relying on the current model of a defined preclinical curricula followed by inconsistent reinforcement throughout clinical rotations.…”

“…The desire to streamline physical examination instruction stems from a perceived need to eliminate maneuvers of "little clinical or educational value" [Gowda et al, 2014b] and to impart learners with more effective clinical reasoning skills [Yudkowsky et al, 2009]. While the hypothesis-driven approach and the core and clusters model both hint at the concept of value, they do not explicitly address how a more selective physical examination allows trainees to deliver HVC.…”

“…In the past decade, a task force convened by the AAMC provided a blueprint for today's clinical skills curricula [AAMC, 2008]. Since this AAMC report, the concept of teaching and assessing learners on a hypothesis-driven physical examination has emerged as an alternative to the traditional approach of teaching head-to-toe examinations [Yudkowsky et al, 2009]. Other educators have subsequently called for a streamlined 'core and clusters' approach in which learners master a foundational basic examination and augment this exam with clusters of maneuvers specific to the clinical context [Gowda et al, 2014a;Gowda et al, 2014b].…”

Teaching a Hypothesis-driven Physical Diagnosis Curriculum to Pulmonary Fellows Improves Performance of First-Year Medical Students

“…In the past decade, the hypothesisdriven physical examination has emerged as a way of conducting the physical examination that enhances its usefulness as a diagnostic modality (4). As opposed to the traditional head-to-toe (HTT) examination, hypothesisdriven physical examination uses a patient's specific complaint to direct the physical exam and contextualize its findings (5-7).…”

Getting Physical: The Hypothesis Driven Physical Exam

“…3 The "head-to-toe" approach can help students practice complex maneuvers and develop an awareness of normal findings, but it has limitations in emphasizing the diagnostic relevance of the physical examination. 4 Teachers should guide students to transition from a head-to-toe physical examination to one used to support or refute potential diagnoses.…”