Hypothesis-Driven Physical Examination Student Handbook

Abstract

Abstract A common approach to teaching and assessing the physical exam is to have medical students first learn 140 or so maneuvers, from head to toes, and then demonstrate mastery of the maneuvers using a standardized patient checklist. This approach tends to decontextualize the physical exam. While students can learn the individual maneuvers, they may be unable to put the pieces together in a useful structural pattern that they can use to analyze and sort out a differential diagnosis at the bedside. The Hypothesis-Driven Physical Examination (HDPE) was originally developed as an assessment procedure in which students use a differential diagnosis to anticipate discriminating physical findings, execute the maneuvers, appreciate the patient's findings, and interpret the findings by offering the most likely diagnosis. This resource, the HDPE Student Study Guide, contains 160 physical exam maneuvers grouped according to 19 chief complaints, each with three to four relevant prototypical diagnoses, for a total of 60 distinct diagnoses. The maneuvers are presented as a series of charts. Medical students tested with this HDPE procedure, which included immediate feedback from a patient instructor (specialized standardized patient), performed better 1 year later. As few as 12 cases can be used to reliably (Cronbach's α >.80) assess mastery. The main purpose of the HDPE is to promote contextualized and meaningful learning and help provide a more selective approach to physical diagnosis, focusing on key, discriminating clinical findings as well as an array of structural patterns that can facilitate transfer from preclinical to clinical settings and from patient to patient.

Keywords

• Physical Examination
• Maneuvers
• Checklist
• Chief Complaint