LAUSR

Medical students have re-entered their clinical training in a milieu that is vastly different from the one familiar to us. The coronavirus disease 2019 (COVID-19) pandemic shifted vital curriculum into the virtual setting; however, some aspects of clinical education are immobile because they are rooted to one thing: bedside teaching. Physical examination (PE) is one such example. The atrophy of PE skills leads to the increased cost of care and diagnostic error, making the teaching of these skills indispensable. The need to conserve personal protective equipment and limitations on student–patient interactions decrease learner time at the bedside. The pandemic also placed limitations on radiographic test ordering because of the increased time required to sterilize equipment and rooms. As such, teaching methods that encourage students to rely on PE as part of their diagnostic reasoning are needed. This education must be flexible, balancing the need for time at the bedside with methods that allow some of the teaching to occur away from the patient to reduce potential viral exposure. Medical students are frequently taught the “head-to-toe” (HTT) examination before clerkships, but clinical teachers lack the time to teach and provide feedback on this method. Experienced clinicians tailor the PE for a specific patient based on their history and clinical presentation. The hypothesis-driven physical examination (HDPE) is a framework that applies the PE in a context-specific, directed approach based on the likelihood of a suspected diagnosis. This approach places PE teaching within the framework of clinical reasoning, more closely reflecting the PEs performed by practicing physicians. A survey of 106 Liaison Committee on Medical Education–accredited medical schools revealed that 56% of medical schools taught a combination of a comprehensive (HTT) approach combined with a clinical