Accepted for/Published in: JMIR Medical Education
Date Submitted: Sep 16, 2024
Date Accepted: Mar 6, 2025
Implementing the H&P 360 in Three Medical Institutions: Usability Study
ABSTRACT
Background:
The traditional History and Physical (H&P) provides the basis for physicians’ data gathering, problem formulation, and care planning, yet can miss relevant behavioral or social drivers of health. The “H&P 360,” a modified H&P, has been shown to foster information gathering and patient rapport in inpatient and OSCE encounters. It prompts students to explore seven domains - biomedical problems; psychosocial problems; patients’ priorities and goals; behavioral history; relationships; living environment and resources; and functional status - as appropriate to the clinical context.
Objective:
The goal of this study was to examine the perceived utility of the H&P 360 outside of standardized patient setting.
Methods:
Three institutions implemented the H&P 360 in different clinical settings. Of the 207 student participants, 18 were pre-clerkship, 126 were clerkship, and 63 were post-clerkship. Three to eight months after implementation, we administered a student survey with 14 Likert-type (1=strongly disagree to 5=strongly agree) and three free text-response items querying utility.
Results:
Overall student response rate was 30%. Among all students, mean ratings on the three utility survey items ranged from 4.03 to 4.24. The five impact on patient care items had mean ratings of 3.88 to 4.24. Mean ratings for the two student learning items were 4.10 and 4.16. Students’ open-ended comments were generally positive and expressed a perceived value in obtaining a more complete contextual picture of the patients’ conditions and support for the utility of the H&P 360. Survey response patterns varied across institutions and learner levels.
Conclusions:
Our findings show that utilizing the H&P 360 can promote information gathering critical for chronic disease management, especially around social drivers of health. As a new standard, the H&P 360 may have clinical utility for revealing and addressing health inequities. Future work should measure effects on patient care and outcomes. Clinical Trial: N/A
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