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Resources Used to Teach the Physical Exam to Preclerkship Medical Students: Results of a National Survey

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

doi: 10.1097/ACM.0000000000002051
Research Reports

Purpose To examine resources used in 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 resources and pedagogical methods employed in preclerkship physical exam curricula. The survey was sent to all 141 Liaison Committee on Medical Education–accredited medical schools in October 2015. Results were averaged across schools, and data were weighted by class size.

Results Results from 106 medical schools (75% response rate) identified a median of 59 hours devoted to teaching the physical exam. Thirty-eight percent of time spent teaching the physical exam involved the use of standardized patients, 30% used peer-to-peer practice, and 25% involved examining actual patients. Approximately half of practice time with actual patients was observed by faculty. At 48% of schools (51), less than 15% of practice time was with actual patients, and at 20% of schools (21) faculty never observed students practicing with actual patients. Forty-eight percent of schools (51) did not provide compensation for their outpatient clinical preceptors.

Conclusions There is wide variation in the resources used to teach the physical examination to preclerkship medical students. At some schools, the amount of faculty observation of students examining actual patients may not be enough for students to achieve competency. A significant percentage of faculty teaching the physical exam remain uncompensated for their effort. Improving faculty compensation and increasing use of senior students as teachers might allow for greater observation and feedback and improved physical exam skills among students.

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

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

A.D. Blood is director of curriculum and education management, Rush Medical College, Rush University, Chicago, Illinois, and a doctoral candidate in health professions education, University of Illinois at Chicago, Chicago, Illinois; ORCID:

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

J.M. Farnan is associate professor of medicine, assistant dean, Curricular Innovation and Evaluation, and director, Clinical Skills Education, University of Chicago Pritzker School of Medicine, Chicago, Illinois.

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

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.

R.K. Ovitsh is assistant professor of pediatrics and assistant dean, Clinical Competencies, SUNY Downstate College of Medicine, Brooklyn, New York.

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

R. Silvestri is assistant professor of medicine and site director, Practice 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.

© 2018 by the Association of American Medical Colleges