Abstract
BACKGROUND: Physical exam skills of medical trainees are declining, but most residencies do not offer systematic clinical skills teaching or assessment. OBJECTIVE: To assess knowledge of clinical signs and physical exam performance among incoming internal medicine residents. METHOD: For this study, 45 incoming residents completed a multiple choice question test to assess knowledge of clinical signs. A random selection of 20 underwent a faculty-observed objective structured clinical examination (OSCE) using patients with abnormal physical findings. Mean percentage scores were computed for the multiple choice question test, overall OSCE, and the 5 individual OSCE systems. RESULTS: The mean scores were 58.4% (14.6 of 25; SD 11. 5) for the multiple choice question test and 54.7% (31.7 of 58; SD 11.0) for the overall OSCE. Mean OSCE scores by system were cardiovascular 30.0%, pulmonary 69.2%, abdominal 61.6%, neurologic 67.0%, and musculoskeletal 41.7%. Analysis of variance showed a difference in OSCE system scores (P < .001) with cardiovascular and musculoskeletal scores significantly lower than other systems. CONCLUSION: Overall, physical exam knowledge and performance of new residents were unsatisfactory. There appears to be a pressing need for additional clinical skills training during medical school and residency training and we are planning a new clinical skills curriculum to address this deficiency.