International Research Center for Medical Education, The University of Tokyo, Japan.
Med Teach. 2011;33(5):410-7. doi: 10.3109/0142159X.2010.540269. Epub 2011 Feb 28.
The physical examination is an essential clinical competence for all physicians. Most medical schools have students who learn the physical examination maneuvers using a head-to-toe approach. However, this promotes a rote approach to the physical exam, and it is not uncommon for students later on to fail to appreciate the meaning of abnormal findings and their contribution to the diagnostic reasoning process. The purpose of the project was to develop a model teaching session for the hypothesis-driven physical examination (HDPE) approach in which students could practice the physical examination in the context of diagnostic reasoning.
We used an action research methodology to create this HDPE model by developing a teaching session, implementing it over 100 times with approximately 700 students, conducting internal reflection and external evaluations, and making adjustments as needed.
A model nine-step HDPE teaching session was developed, including: (1) orientation, (2) anticipation, (3) preparation, (4) role play, (5) discussion-1, (6) answers, (7) discussion-2, (8) demonstration and (9) reflection.
A structured model HDPE teaching session and tutor guide were developed into a workable instructional intervention. Faculty members are invited to teach the physical examination using this model.
体格检查是所有医生必备的临床技能。大多数医学院校的学生都是通过从头到脚的方法学习体格检查操作。然而，这种方法促进了对体格检查的死记硬背，学生后来常常无法理解异常发现的意义及其对诊断推理过程的贡献，这种情况并不少见。本项目旨在开发一种假设驱动的体格检查（HDPE）方法的示范教学课程，使学生能够在诊断推理的背景下练习体格检查。
我们使用行动研究方法，通过开发一个教学课程，在大约 700 名学生中实施了 100 多次，进行内部反思和外部评估，并根据需要进行调整，从而创建了这种 HDPE 模型。
制定了一个九步 HDPE 教学课程，包括：（1）定位，（2）预期，（3）准备，（4）角色扮演，（5）讨论-1，（6）答案，（7）讨论-2，（8）演示和（9）反思。
制定了一种结构化的 HDPE 教学模型和导师指南，将其发展成为一种可行的教学干预措施。邀请教师使用这种模式教授体格检查。
