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Sunday, February 26 • 11:00am - 11:45am
SUNDANCE - [Oral Presentation] 3. Bridging the Gap: Integrating Hypothesis-Driven Physical Exam and Clinical Reasoning for the 21st Century Physician

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11:30 AM - 11:45 AM

Bridging the Gap: Integrating Hypothesis-Driven Physical Exam and Clinical Reasoning for the 21st Century Physician   

S. Narayana, H. Nye, A. Chang, J. Stein, A. Richards, A. Ishizaki, S. Cornes, Neurology, UCSF 
Abstract Body: Context: The physician physical exam (PE) is a core skill that yields data for clinical decisions. Inaccuracies, missed maneuvers and misinterpretation of physical findings contribute to medical error. PE learning taught in a “head-to-toe” manner may lack clinical context. Many experts advocate learning diagnosis-focused (“hypothesis-driven”) PE to facilitate retention and integrate clinical reasoning. The optimal instructional method for early learners in this vein has yet been determined. Objectives: Design and implement case-based standardized patient (SP) sessions in which first and second-year medical students apply history-taking and hypothesis-driven PE skills, while integrating the clinical reasoning principles of data acquisition, problem representation, and illness scripts. Key Message: With expert input, we identified 12 essential chief complaints: fatigue, weight loss, shortness of breath, ear pain, vision loss, loss of consciousness, shoulder pain, abdominal pain, falls, cognitive impairment, rash and fever. We subsequently developed seven four-hour SP sessions around these chief complaints. Each session begins with a faculty didactic on essential concepts related to the upcoming SP encounter (e.g. how to identify various cardiac sounds, how to take vital signs, how to hold the otoscope, etc). Students then obtain a focused history and complete a PE. Abnormal PE findings are simulated when appropriate. While one student is performing these clinical skills, another functions as a time-keeper and prompts her peer with possible PE maneuvers from a comprehensive checklist developed by local content area experts. Meanwhile, the third student in the room is developing an evolving problem representation and differential diagnosis as data is acquired from the history and PE. At the end of the session, students regroup with their faculty preceptor to discuss their problem representation and differential. Prior to each session, students are expected to watch skills-based videos or read content-relevant material and complete an online self-assessment as preparation. During each session, students receive focused feedback from their preceptor on their history-taking and PE technique. They also receive feedback from their SPs on communication, basic PE technique, and flow of the clinical encounter. We recruited SPs to be representative of a diverse patient population and uphold an institutional mission to promote inclusion. The evaluation plan includes: 1. Focus groups with students and faculty. 2. Observed Standardized Clinical Encounters (OSCE) performance. Conclusion: A clinical skills curriculum incorporating focused history-taking, hypothesis-driven physical exam, and clinical reasoning principles, is feasible and may address the gap of integration of previously isolated clinical skill techniques. 



Sunday February 26, 2017 11:00am - 11:45am
SUNDANCE

Attendees (22)