Implementing the H&P 360 in Three Medical Institutions: Usability Study

TL;DR

This study evaluates how well medical students can use a modified history and physical (H&P 360) in real clinical settings, finding it generally useful for gathering patient information and improving care.

Contribution

The study provides new insights into the usability of the H&P 360 in real-world clinical settings, beyond controlled environments.

Findings

Students rated the H&P 360 usability and impact on patient care with high mean scores (4.03 to 4.24).

Open-ended feedback was largely positive, highlighting the tool's value in capturing patients' full context.

Survey responses varied by institution and learner level, suggesting context-dependent usability.

Abstract

The 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.

This study aims to examine the perceived usability of the H&P 360 outside standardized patient settings.

The 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.

Of 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.

Our 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.