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Approaches to Teaching the Physical Exam to Preclerkship Medical Students

Results of a National Survey

Uchida, Toshiko, MD; Park, Yoon Soo, PhD; Ovitsh, Robin K., MD; Hojsak, Joanne, MD; Gowda, Deepthiman, MD, MPH; Farnan, Jeanne M., MD, MHPE; Boyle, Mary, MD; Blood, Angela D., MPH, MBA; Achike, Francis I., MD, PhD, MEd; Silvestri, Ronald C., MD

doi: 10.1097/ACM.0000000000002433
Research Reports

Purpose To assess current approaches to teaching the physical exam to preclerkship students at U.S. medical schools.

Method The Directors of Clinical Skills Courses developed a 49-question survey addressing the approach, pedagogical methods, and assessment methods of preclerkship physical exam curricula. The survey was administered to all 141 Liaison Committee on Medical Education–accredited U.S. medical schools in October 2015. Results were aggregated across schools, and survey weights were used to adjust for response rate and school size.

Results One hundred six medical schools (75%) responded. Seventy-nine percent of schools (84) began teaching the physical exam within the first two months of medical school. Fifty-six percent of schools (59) employed both a “head-to-toe” comprehensive approach and a clinical reasoning approach. Twenty-three percent (24) taught a portion of the physical exam interprofessionally. Videos, online modules, and simulators were used widely, and 39% of schools (41) used bedside ultrasonography. Schools reported a median of 4 formative assessments and 3 summative assessments, with 16% of schools (17) using criterion-based standard-setting methods for physical exam assessments. Results did not vary significantly by school size.

Conclusions There was wide variation in how medical schools taught the physical exam to preclerkship students. Common pedagogical approaches included early initiation of physical exam instruction, use of technology, and methods that support clinical reasoning and competency-based medical education. Approaches used by a minority of schools included interprofessional education, ultrasound, and criterion-based standard-setting methods for assessments. Opportunities abound for research into the optimal methods for teaching the physical exam.

T. Uchida is associate professor of medicine and medical education and director of clinical skills education, Northwestern University Feinberg School of Medicine, Chicago, Illinois; ORCID:

Y.S. Park is associate professor of medical education, University of Illinois at Chicago College of Medicine, Chicago, Illinois; ORCID:

R.K. Ovitsh is assistant professor of pediatrics and assistant dean for clinical competencies, SUNY Downstate College of Medicine, Brooklyn, New York.

J. Hojsak is associate professor of pediatrics and medical education and course codirector, The Art and Science of Medicine, Years 1 and 2, Icahn School of Medicine at Mount Sinai, New York, New York.

D. Gowda is associate professor of medicine and course director, Foundations of Clinical Medicine Tutorials, Columbia University Vagelos College of Physicians and Surgeons, New York, New York; ORCID:

J.M. Farnan is associate professor of medicine, associate dean for evaluation and continuous quality improvement, and director of clinical skills education, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

M. Boyle is clinical associate professor of emergency medicine, assistant dean for clinical formation, and course director, Patient Centered Medicine 2, Loyola Stritch School of Medicine, Maywood, Illinois.

A.D. Blood is director of curricular resources, Association of American Medical Colleges, Washington, DC, and doctoral candidate in health professions education, University of Illinois at Chicago, Chicago, Illinois; ORCID:

F.I. Achike is professor of pharmacology, clinical skills, and anesthesiology; director, Clinical Skills and Simulation Program; and associate dean for interprofessional education, California University of Science and Medicine School of Medicine, Colton, California.

R.C. Silvestri is assistant professor of medicine, Harvard Medical School, Boston, Massachusetts; ORCID:

Funding/Support: Funds from the DOCS general account were used to pay the Department of Medical Education at the University of Illinois at Chicago for Dr. Park’s time as a methodologic and statistical consultant. There was no external funding for this project.

Other disclosures: None reported.

Ethical approval: The Institutional Review Board at the University of Chicago Pritzker School of Medicine has determined that the survey is exempt from further review under federal regulations (45 CFR 46.101(b)).

Supplemental digital content for this article is available at

Correspondence should be addressed to Toshiko Uchida, Clinical Education Center, Northwestern University Feinberg School of Medicine, 240 E. Huron St., Room 1-443, Chicago, IL 60611; telephone: (312) 503-6486; e-mail:; Twitter: @nufeinbergmed.

© 2019 by the Association of American Medical Colleges