730 - Implementing a Longitudinal Physical Exam Curriculum for Pediatric Residents

Publication Number: 3706.730

Erin Keizur, UCSF Benioff Children's Hospital Oakland, San Francisco, CA, United States; Lauren Lin, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States; April Zaat, UCSF Benioff Children's Hospital Oakland, Oakland, CA, United States

Background: In residency, it is expected that learners continue to improve their physical exam skills, yet formal programs to teach exams are uncommon. Most teaching occurs during medical school, with variability of how that training is provided. Surveys show medical students feel less prepared to perform pediatric physical exam skills compared to skills in other clerkships. Barriers to learning physical exams in residency include lack of attending feedback and time limitations. Prior residency interventions to address this gap in training have often been lecture based, single sessions, or lacked direct patient practice.

Objective: We aimed to improve resident comfort level and skill performing pediatric physical exams through an initial needs assessment and longitudinal curriculum implementation.

Design/Methods: Using Kern's curricular development framework, we began with a needs assessment among residents to identify perceived weaknesses in physical exam skills. We then performed purposive sampling of expert educators among pediatric subspecialties to determine physical exam skills they identified as most important for pediatric residents to learn. Responses were combined into a checklist of core pediatric physical exam maneuvers. We did not seek formal IRB review given the educational nature of the research and minimal risk.

Results: We obtained 53 survey responses (64% response rate) from pediatric residents. The exam maneuvers with the lowest reported comfort in performing were otoscopic (56%), fundoscopic (79%), musculoskeletal (65%), and reflexes (48%). We obtained responses from attendings across twelve subspecialty clinics regarding key physical exam maneuvers (Figure 1). These findings informed the development of a physical exam checklist tool used to monitor skills practiced and provide structured attending feedback (Figure 2).

Conclusion(s): Both residents and attendings identified gaps in education and areas for improvement in resident physical exam training. In response, our developed checklist was incorporated into learning goals for pediatric interns during a 2-week outpatient rotation starting June 2025. Checklist responses will be completed by June 2026 by all 32 pediatric interns. Ongoing evaluation of checklists and small group discussions with residents will assess learning and areas for improvement. Establishing our longitudinal, structured physical exam curriculum in the outpatient setting can address previously identified barriers. This curriculum may be adapted to other programs to improve training for all pediatric residents.

Figure 1
Represented subspecialties from purposeful sampling of attending physicians regarding important physical exam maneuvers for pediatric residents to learn.

Figure 2
Checklist of identified pediatric physical exam maneuvers to be used by resident physicians during an outpatient subspecialty rotation to document exam practice and attending feedback.