title: Teaching a Hypothesis-driven Physical Diagnosis Curriculum to Pulmonary Fellows Improves Performance of First-Year Medical Students.
abstract: BACKGROUND
  Hypothesis-driven physical examination emphasizes the role of bedside examination in the refinement of differential diagnoses and improves diagnostic acumen. This approach has not yet been investigated as a tool to improve the ability of higher-level trainees to teach medical students.
  
  
  OBJECTIVE
  To assess the effect of teaching hypothesis-driven physical diagnosis to pulmonary fellows on their ability to improve the pulmonary examination skills of first-year medical students.
  
  
  METHODS
  Fellows and students were assessed on teaching and diagnostic skills by self-rating on a Likert scale. One group of fellows received the hypothesis-driven teaching curriculum (the "intervention" group) and another received instruction on head-to-toe examination. Both groups subsequently taught physical diagnosis to a group of first-year medical students. An oral examination was administered to all students after completion of the course.
  
  
  RESULTS
  Fellows were comfortable teaching physical diagnosis to students. Students in both groups reported a lack of comfort with the pulmonary examination at the beginning of the course and improvement in their comfort by the end. Students trained by intervention group fellows outperformed students trained by control group fellows in the interpretation of physical findings (P < 0.05).
  
  
  CONCLUSIONS
  Teaching hypothesis-driven physical examination to higher-level trainees who teach medical students improves the ability of students to interpret physical findings. This benefit should be confirmed using validated testing tools.
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Bashar S
authors.initials: BS
authors.lastname: Staitieh
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Ramin
authors.initials: R
authors.lastname: Saghafi
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Jordan A
authors.initials: JA
authors.lastname: Kempker
authors.affiliation: Department of Medicine, Division of Pulmonary, Allergy, Critical Care Medicine, and Sleep Medicine, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: David A
authors.initials: DA
authors.lastname: Schulman
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000592:standards*; D005845:Georgia; D006801:Humans; D010808:Physical Examination / Q000379:methods*; D011446:Prospective Studies; D015272:Pulmonary Medicine / Q000193:education*; D013337:Students, Medical; D013663:Teaching / Q000592:standards*
keywords: hypothesis-driven physical examination; medical education