A Hypothesis-Driven, Near-Peer Physical Diagnosis Module on Streptococcal Pharyngitis Within the Pediatrics Clerkship

Abstract

Introduction In busy clinical settings, there is limited time to teach physical examination (PE) and procedural skills, particularly when the traditional head-to-toe PE approach is time-consuming. Near-peer teaching of a more efficient approach, the hypothesis-driven PE (HDPE), increases students’ learning opportunities. We developed a near-peer HDPE module to improve medical student confidence, knowledge, and skills for diagnosing and managing streptococcal pharyngitis. Methods During this 1-hour module, residents taught the diagnostic approach for a patient with sore throat and facilitated small groups for practicing PE and throat swab skills. We assessed students using pre- and postmodule surveys including Likert-scale confidence scores (1 = not at all confident, 5= extremely confident), multiple-choice knowledge questions, and a skills rubric. A control group was surveyed at clerkship conclusion. Results Of the 71 pediatric clerkship students who participated, 69 (97%) completed premodule surveys and 65 (91%) completed skills assessments. Twenty-eight (39%) completed postmodule surveys and skill assessments. After participation, students’ survey responses and rubrics indicated significant increase in confidence (Mdnpre = 2 [IQR = 1,2], Mdnpost = 4 [IQR = 4,5]; p < .001), knowledge (Mpre = 40%, Mpost = 77%; p < .001), and skills (Mpre = 5.3, Mpost = 7.5; p < .01). Participating students also had significantly higher confidence (p < .005) and knowledge (p < 0.01) compared to the control group. Discussion This near-peer HDPE module improved students’ knowledge, confidence, and skills related to streptococcal pharyngitis diagnosis and management and achieved compliance for a required clerkship skill.

Keywords

• Physical Examination
• Physical Diagnosis
• Near-Peer Learning
• Residents as Teachers
• Pediatrics
• Clinical Skills Assessment/OSCEs