Impact of Explicit, Implicit, and Extra Curricula on Students’ Learning of the History and Physical Examination

This article was migrated. The article was not marked as recommended. Purpose : History taking and physical examination (H&P) in a patient-centered manner is central to the practice of medicine. This qualitative case study explored the relative influences of explicit, implicit, and extra curricula on medical students' learning of the H&P. Methods : The authors conducted semi-structured interviews with 15 fourth-year medical students at Columbia University from September 2015 to January 2016. The authors coded interview transcripts in an iterative process, and clustered coded data into emerging themes to elucidate how curricula shaped students' learning of the H&P. Results : Students perceived misalignment between curricula, with two predominant patterns: lesser emphasis on patient-centered H&P and greater emphasis on hypothesis-driven H&P in implicit versus explicit curricula. Role models, patient interactions, and clinical context were important influences on students' learning of patient-centered H&P. Ward rounds, role models, and feedback were particularly impactful for students' learning of hypothesis-driven H&P. Students reported minimal learning from the extra curriculum. Conclusions : Medical students perceived a misalignment in learning the H&P between the explicit and implicit curricula, with the former being primarily where students developed patient-centeredness in conducting H&Ps and the latter being where students learned to conduct hypothesis-driven H&P. Efforts to align curricula could strengthen H&P training.