Core + Clusters: A Practical Clinical Reasoning‐Based Toolkit for Revitalizing Physical Diagnosis Training

The way we teach physical diagnosis needs to be revitalized. Medical students now see patients in their first year, and the traditional head-to-toe physical exam (HTTE) can be overwhelming with its over 100 manoeuvres and does not give learners physical exam readiness for early clinical work. We have developed and implemented Core + Clusters (C + C). C + C begins with a streamlined Core Exam, with approximately 40 manoeuvres, that prepares learners for early clinical experiences. Diagnostic Clusters, the second component of C + C, are sets of history-taking questions and physical examination manoeuvres critical to discriminating among diagnoses in common clinical presentations. They build on prior education models by combining hypothesis-driven history-taking with hypothesis-driven physical examination to better resemble clinical practice. The C + C model is feasible, requires resources similar to those used in the HTTE curriculum and is flexible enough to adapt to the curricula of diverse institutions. In this paper we offer a C + C toolkit which describes the C + C components, gives examples of curricular implementation and shares lessons we have learned from over 10 years of experience with C + C.