Allen Sharon, Olson Andrew, Menk Jeremiah, Nixon James
Department of Family Medicine, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Departments of Internal Medicine and Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, USA.
Clin Teach. 2017 Dec;14(6):417-422. doi: 10.1111/tct.12581. Epub 2016 Dec 9.
Medical students traditionally learn physical examination skills as a rote list of manoeuvres. Alternatives like hypothesis-driven physical examination (HDPE) may promote students' understanding of the contribution of physical examination to diagnostic reasoning. We sought to determine whether first-year medical students can effectively learn to perform a physical examination using an HDPE approach, and then tailor the examination to specific clinical scenarios. Medical students traditionally learn physical examination skills as a rote list of manoeuvres CONTEXT: First-year medical students at the University of Minnesota were taught both traditional and HDPE approaches during a required 17-week clinical skills course in their first semester. The end-of-course evaluation assessed HDPE skills: students were assigned one of two cardiopulmonary cases. Each case included two diagnostic hypotheses. During an interaction with a standardised patient, students were asked to select physical examination manoeuvres in order to make a final diagnosis. Items were weighted and selection order was recorded.
First-year students with minimal pathophysiology performed well. All students selected the correct diagnosis. Importantly, students varied the order when selecting examination manoeuvres depending on the diagnoses under consideration, demonstrating early clinical decision-making skills.
An early introduction to HDPE may reinforce physical examination skills for hypothesis generation and testing, and can foster early clinical decision-making skills. This has important implications for further research in physical examination instruction.
传统上，医学生将体格检查技能当作一系列机械的操作来学习。像基于假设的体格检查（HDPE）这样的替代方法可能会促进学生理解体格检查对诊断推理的作用。我们试图确定一年级医学生是否能够有效地学会使用HDPE方法进行体格检查，然后根据特定临床场景调整检查。传统上，医学生将体格检查技能当作一系列机械的操作来学习。背景：明尼苏达大学的一年级医学生在第一学期为期17周的必修临床技能课程中学习了传统方法和HDPE方法。课程结束时的评估对HDPE技能进行了考核：学生被分配到两个心肺病例中的一个。每个病例包含两个诊断假设。在与标准化病人互动时，要求学生选择体格检查操作以做出最终诊断。对各项进行加权并记录选择顺序。
病理生理学知识最少的一年级学生表现良好。所有学生都做出了正确诊断。重要的是，学生在选择检查操作时会根据所考虑的诊断改变顺序，展现出了早期临床决策技能。
尽早引入HDPE可能会加强用于假设生成和检验的体格检查技能，并能培养早期临床决策技能。这对体格检查教学的进一步研究具有重要意义。
