ObjectiveTo investigate the diversity in teaching difficulty and effects in the online course of the physical examination in medical undergraduates, and to propose rationalized rearrangements of the teaching content in blended online and offline teaching. MethodsThree hundred and eleven undergraduate medical students in Xiangya Hospital of Central South University, who participated in the online course of diagnostics in March to June 2020 and completed the final test of physical examination through intelligent network learning platform, were retrospectively analyzed. Analysis of test scores were stratified according to different parts and item subtypes.Meanwhile, course participants(8 teachers and 311 students) were surveyed by online questionnaire about the teaching difficulty and effects of different parts in physical examination. ResultsAmong 8 parts of physical examination test, score of the abdominal examination was relatively lower (F=19.59，P＜0.01), while scores of the cardiac and spineextremities examinations were higher than those of the other 7 parts (F=13.11,17.85,all P＜0.01). Score of the operational items of the abdominal examination was lower than those of the other 7 parts (F=83.01,P＜0.01), with no distinct difference in

theoretical items (F=1.29, P＞0.05). While scores of the neck, cardiac and spine-extremities examinations were higher in operational items (F=24.68, 7.61, 21.48, all P＜0.01). In questionnaire survey, teachers and students all considered theabdominal, lung and cardiac examinations were more difficult with poorer effects in the online course. ConclusionsThe online teaching of physical examination has obvious differences in teaching difficulty according to the specific teaching content. Therefore, when carrying out online and offline mixed teaching, we should optimize the content design according to the differences, so as to improve the teaching effect.