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A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence.
Med Educ. 2009 Aug; 43(8):729-40.ME

Abstract

CONTEXT

Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges.

OBJECTIVES

This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure.

METHODS

Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination.

RESULTS

On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only.

CONCLUSIONS

The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner.

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Authors+Show Affiliations

Yudkowsky R
Department of Medical Education, College of Medicine, University of Illinois at Chicago, Chicago, Illinois 50612, USA. rachely@uic.edu
Otaki J
No affiliation info available
Lowenstein T
No affiliation info available
Riddle J
No affiliation info available
Nishigori H
No affiliation info available
Bordage G
No affiliation info available

MeSH

Clinical CompetenceCompetency-Based EducationDiagnosis, DifferentialEducation, Medical, UndergraduateEducational MeasurementEvaluation Studies as TopicFeedbackHumansPhysical Examination

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

19659486

Citation

Yudkowsky, Rachel, et al. "A Hypothesis-driven Physical Examination Learning and Assessment Procedure for Medical Students: Initial Validity Evidence." Medical Education, vol. 43, no. 8, 2009, pp. 729-40.
Yudkowsky R, Otaki J, Lowenstein T, et al. A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Med Educ. 2009;43(8):729-40.
Yudkowsky, R., Otaki, J., Lowenstein, T., Riddle, J., Nishigori, H., & Bordage, G. (2009). A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. Medical Education, 43(8), 729-40. https://doi.org/10.1111/j.1365-2923.2009.03379.x
Yudkowsky R, et al. A Hypothesis-driven Physical Examination Learning and Assessment Procedure for Medical Students: Initial Validity Evidence. Med Educ. 2009;43(8):729-40. PubMed PMID: 19659486.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A hypothesis-driven physical examination learning and assessment procedure for medical students: initial validity evidence. AU - Yudkowsky,Rachel, AU - Otaki,Junji, AU - Lowenstein,Tali, AU - Riddle,Janet, AU - Nishigori,Hiroshi, AU - Bordage,Georges, PY - 2009/8/8/entrez PY - 2009/8/8/pubmed PY - 2010/1/23/medline SP - 729 EP - 40 JF - Medical education JO - Med Educ VL - 43 IS - 8 N2 - CONTEXT: Diagnostic accuracy is maximised by having clinical signs and diagnostic hypotheses in mind during the physical examination (PE). This diagnostic reasoning approach contrasts with the rote, hypothesis-free screening PE learned by many medical students. A hypothesis-driven PE (HDPE) learning and assessment procedure was developed to provide targeted practice and assessment in anticipating, eliciting and interpreting critical aspects of the PE in the context of diagnostic challenges. OBJECTIVES: This study was designed to obtain initial content validity evidence, performance and reliability estimates, and impact data for the HDPE procedure. METHODS: Nineteen clinical scenarios were developed, covering 160 PE manoeuvres. A total of 66 Year 3 medical students prepared for and encountered three clinical scenarios during required formative assessments. For each case, students listed anticipated positive PE findings for two plausible diagnoses before examining the patient; examined a standardised patient (SP) simulating one of the diagnoses; received immediate feedback from the SP, and documented their findings and working diagnosis. The same students later encountered some of the scenarios during their Year 4 clinical skills examination. RESULTS: On average, Year 3 students anticipated 65% of the positive findings, correctly performed 88% of the PE manoeuvres and documented 61% of the findings. Year 4 students anticipated and elicited fewer findings overall, but achieved proportionally more discriminating findings, thereby more efficiently achieving a diagnostic accuracy equivalent to that of students in Year 3. Year 4 students performed better on cases on which they had received feedback as Year 3 students. Twelve cases would provide a reliability of 0.80, based on discriminating checklist items only. CONCLUSIONS: The HDPE provided medical students with a thoughtful, deliberate approach to learning and assessing PE skills in a valid and reliable manner. SN - 1365-2923 UR - https://www.unboundmedicine.com/medline/citation/19659486/A_hypothesis_driven_physical_examination_learning_and_assessment_procedure_for_medical_students:_initial_validity_evidence_ L2 - https://doi.org/10.1111/j.1365-2923.2009.03379.x DB - PRIME DP - Unbound Medicine ER -