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

Julia Kelly, Sandra K. Oza, Richard Feinn, Todd Cassese

Research output: Contribution to journalArticlepeer-review


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.

Original languageEnglish (US)
Pages (from-to)11043
Number of pages1
JournalMedEdPORTAL : the journal of teaching and learning resources
StatePublished - Nov 24 2020


  • Clinical Reasoning
  • Clinical Reasoning/Diagnostic Reasoning
  • Clinical Skills
  • Clinical/Procedural Skills Training
  • Hypothesis-Driven Physical Examination
  • Physical Examination

ASJC Scopus subject areas

  • Medicine(all)


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