ArticleJMIR medical education2025
Implementing the H&P 360 in Three Medical Institutions: Usability Study.
Article in JMIR medical education, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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11 authors.
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Abstract
backgroundThe traditional history and physical (H&P) provides the basis for physicians' data gathering, problem formulation, and care planning, yet it can miss relevant behavioral or social risk factors. The American Medical Association's "H&P 360," a modified H&P, has been shown to foster information gathering and patient rapport in inpatient settings and objective structured clinical examinations. It prompts students to explore 7 domains, as appropriate to the clinical context: biomedical problems, psychosocial problems, patients' priorities and goals, behavioral history, relationships, living environment and resources, and functional status.
objectiveThis study aims to examine the perceived usability of the H&P 360 outside standardized patient settings.
methodsThe H&P 360 was implemented in various clinical settings across 3 institutions. Of the 207 student participants, 18 were preclerkship, 126 were clerkship, and 63 were postclerkship; 3-8 months after implementation, we administered a student survey consisting of 14 Likert-type items (1=strongly disagree to 5=strongly agree) and 3 free-text response items to assess usability.
resultsOf the 207 students, 61 responded to the survey (response rate was 29.5%). Among all students, mean ratings on the 3 usability survey items ranged from 4.03 to 4.24. The 5 items assessing the impact on patient care had mean ratings ranging from 3.88 to 4.24. The mean ratings for the 2 student learning items were 4.10 and 4.16. Students' open-ended comments were generally positive, expressing a perceived value in obtaining a more complete contextual picture of patients' conditions and supporting the usability of the H&P 360. Survey response patterns varied across institutions and learner levels.
conclusionsOur findings suggest that using the H&P 360 may enhance information gathering critical for chronic disease management, particularly regarding social drivers of health. As a potential new standard, the H&P 360 may have clinical usability for identifying and addressing health inequities. Future work should assess its effects on patient care and outcomes.
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