Purpose: Medical students are traditionally taught the physical exam as a comprehensive battery of maneuvers, yet they express uncertainty about which maneuvers are “core” and should be performed routinely on patients and which ones should be performed only when clinically indicated. The authors sought to determine whether educator consensus existed on the concept and the specifics of a core physical exam for students.
Method: The authors developed a 45-maneuver core physical exam to be performed by a medicine clerkship student on every newly admitted patient, with the expectation that it would be supplemented by clinically indicated additional maneuvers. From 2011 to 2012 they sent surveys to physical diagnosis course directors (PDCDs) and internal medicine clerkship directors (IMCDs) from all 132 U.S. allopathic medical schools to determine the extent of their agreement with the proposed 45 maneuvers and their opinions about the concept of a core exam.
Results: Seventy-one percent (94/132) of PDCDs and 63% (83/132) of IMCDs responded to the survey. In total, 84% (111/132) of all schools surveyed were represented by either their PDCD or IMCD. Of the 45 proposed maneuvers, 37 were deemed “core” by a majority of respondents. The majority of IMCDs preferred a slightly leaner 37-maneuver core exam than the majority of PDCDs, who voted for 41 maneuvers.
Conclusions: Among PDCDs and IMCDs, there was openness to teaching medical students a streamlined core physical exam to which other maneuvers are added as clinically indicated. These educators closely agreed on the maneuvers this core exam should include.
Dr. Gowda is assistant professor of medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York.
Dr. Blatt is professor of medicine, Department of Medicine, George Washington University School of Medicine, Washington, DC.
Dr. Fink is assistant professor of medicine, Program in Family Medicine, Department of Medicine, Columbia University, College of Physicians and Surgeons, New York, New York.
Dr. Kosowicz is associate professor of medicine, Department of Medicine, University of Connecticut School of Medicine, Farmington, Connecticut.
Ms. Baecker is a PhD candidate in epidemiology, University of California at Los Angeles, Los Angeles, California. At the time of this study, Ms. Baecker was an MPH candidate, Columbia University Mailman School of Public Health, New York, New York.
Dr. Silvestri is assistant professor of medicine, Department of Medicine, Harvard Medical School, and physician, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Editor’s Note: A commentary by T. Uchida, J.M. Farnan, J.E. Schwartz, and H.L. Heiman appears on pages 373–375.
Funding/Support: The study team received an educational innovations grant from the NEGEA to conduct this work.
Other disclosures: None reported.
Ethical approval: This study was approved by the Columbia University Medical Center institutional review board.
Previous presentations: Small Group Discussion, Association of American Medical Colleges 2011 Annual Meeting, Denver, Colorado, and Small Group Discussion, Northeastern Group on Educational Affairs 2011 Annual Meeting, Washington, DC.
Correspondence should be addressed to Dr. Gowda, Hammer Health Sciences Building, Suite 201, Columbia University, College of Physicians and Surgeons, 701 W. 168th St., New York, NY 10032; telephone: (212) 305-2451; e-mail: firstname.lastname@example.org.