Abstract
BACKGROUND AND OBJECTIVES
Little is known about the differences in attitudes of medical students, Internal Medicine residents, and faculty Internists toward the physical examination. We sought to investigate these groups’ self-confidence in and perceived utility of physical examination skills.
DESIGN AND PARTICIPANTS
Cross-sectional survey of third- and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital.
MEASUREMENTS
Using a 5-point Likert-type scale, respondents indicated their self-confidence in overall physical examination skill, as well as their ability to perform 14 individual skills, and how useful they felt the overall physical examination, and each skill, to be for yielding clinically important information.
RESULTS
The response rate was 80% (302/376). The skills with overall mean self-confidence ratings less than “neutral” were interpreting a diastolic murmur (2.9), detecting a thyroid nodule (2.8), and the nondilated fundoscopic examination using an ophthalmoscope to assess retinal vasculature (2.5). No skills had a mean utility rating less than neutral. The skills with the greatest numerical differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma (1.5), detecting a thyroid nodule (1.4), and interpreting a diastolic murmur (1.3). Regarding overall self-confidence, third-year students’ ratings (3.3) were similar to those of first-year residents (3.4; p = .95) but less than those of fourth-year students (3.8; p = .002), upper-level residents (3.7; p = .01), and faculty Internists (3.9; p < .001).
CONCLUSIONS
Self-confidence in the physical exam does not necessarily increase at each stage of training. The differences found between self-confidence and perceived utility for a number of skills suggest important areas for educational interventions.
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Acknowledgments
We appreciate the assistance of Dr. D. Michael Elnicki in the editing of this manuscript. This work was presented as a poster at the 2004 Society of General Internal Medicine Annual Meeting and as an oral abstract at the 2004 Rhode Island Regional Meeting of the American College of Physicians. At the time of the study, Dr. Wu was a resident in General Internal Medicine, and this work was supported by the Melvin D. Hoffman Award from the Division of General Internal Medicine at Rhode Island Hospital. We appreciate the participation of medical students from The Warren Alpert Medical School of Brown University and the medical housestaff and teaching faculty of Rhode Island Hospital.
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Wu, E.H., Fagan, M.J., Reinert, S.E. et al. Self-Confidence in and Perceived Utility of the Physical Examination: A Comparison of Medical Students, Residents, and Faculty Internists. J GEN INTERN MED 22, 1725–1730 (2007). https://doi.org/10.1007/s11606-007-0409-8
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DOI: https://doi.org/10.1007/s11606-007-0409-8