Dr. Georges Bordage
Topic: Promoting Clinical Reasoning Through a Hypothesis-Driven Physical Examination: Anticipating, Eliciting & Interpreting Physical Findings
Date: May 9, 2012
Time: 12:00pm to 1:30pm (Lunch will be served at DHCC)
- Diamond Health Care Centre 2267
- IRC 305
- CWH 2D22
- MSB 210
- RJH 011
- HSC 129
- NHSC 9-370
- UHNBC 5009 (Port #1)
- BCCA 1065
- SMH Hatzic Room at Central City
A common approach to teaching and assessing the physical exam is to have medical students first learn 150 or so maneuvers, from head to toes, and then demonstrate mastery of the maneuvers during a 60 or 90-minute exam where a standardized patient records mastery on a checklist. This approach tends to decontextualize the physical exam. While the students can learn the individual maneuvers, they may be unable to put the pieces together in a useful structural pattern that they can use to analyze and sort out a differential diagnosis at the bedside.
The Hypothesis-Driven Physical Examination assessment procedure is designed to have students use a differential diagnosis to anticipate discriminating physical findings, execute the maneuvers, appreciate the patient’s findings, and interpret the findings by offering a most likely diagnosis. 160 physical exam maneuvers were selected and grouped according to 19 chief complaints, each with 3 to 4 relevant diagnoses, for a total of 60 distinct diagnoses. The main purpose is to promote contextualized, integrated, and meaningful learning, and help provide a more selective approach to physical diagnosis, focusing on key, discriminating findings as well as an array of structural patterns that can facilitate transfer from pre-clinical to clinical settings and from patient to patient.
By the end of the presentation, the participants will be able to:
– Explain the rationale underlying the hypothesis-driven physical examination teaching and assessment procedure;
– Describe the steps in the hypothesis-driven physical examination assessment procedure; and
– Describe various implementation strategies of the hypothesis-driven physical examination.
From 1978 to 1992, Dr. Bordage was a professor in the Office of Health Sciences Education in the Faculty of Medicine at the Université Laval (Québec City) and since 1992, a professor in the Department of Medical Education at University of Illinois at Chicago (UIC). He is also a visiting professor at the University of Bern in Switzerland (2000-) and the University of Tokyo (Japan, 2004-). He was the founding director of a Master’s degree program in Health Sciences Education at Laval and was the director of the Master’s degree program in Health Professions Education at UIC from 1992 to 2003. In addition to four honorary doctoral degrees, Dr. Bordage is the recipient of the 2005 Abraham Flexner Award of the American Association of Medical Colleges, the 1994 John P. Hubbard Award from the NBME, the 1999 Merrel Flair Award of the AAMC Group on Educational Affairs, the 2002 Division I American Education Research Association Distinguished Career Award. He is also a Fellow of the American Education Research Association (2009). His research focuses on three areas of study: (1) the written assessment of clinical competence, the “key features” approach, (2) the relationships between knowledge organization in memory and clinical reasoning, and (3) the quality of scientific writing.
As an organization accredited to sponsor continuing medical education for physicians by the Committee on Accreditation of Canadian Medical Schools (CACMS), the UBC Division of Continuing Professional Development designates this educational program as meeting the accreditation criteria of the College of Family Physicians of Canada for up to 1.5 Mainpro-M1 credits (per session). This program has been reviewed and approved by UBC Division of Continuing Professional Development. Each physician should claim only those credits he/she actually spent in the activity.
The CHES Research Rounds is a self-approved group learning activity (Section 1) as defined by the Maintenance of Certification program of the Royal College of Physicians and Surgeons of Canada.