Journal of General Internal Medicine

, Volume 23, Issue 2, pp 129–134

Detection and Description of Small Breast Masses by Residents Trained Using a Standardized Clinical Breast Exam Curriculum

  • Elizabeth Steiner
  • Donald F. Austin
  • Nancy C. Prouser
Original Article

DOI: 10.1007/s11606-007-0444-5

Cite this article as:
Steiner, E., Austin, D.F. & Prouser, N.C. J GEN INTERN MED (2008) 23: 129. doi:10.1007/s11606-007-0444-5



We evaluated the effect of standardized clinical breast examination (CBE) training on residents’ ability to detect a 3-mm breast mass in a silicone breast model.


In this nonrandomized controlled trial, 75 first year residents (R1s) at 8 family medicine, internal medicine, and obstetrics and gynecology training programs received the intervention and second year residents (R2s) did not. Trained residency faculty taught R1s vertical strip, three-pressure method (VS3PM) CBE using a standardized curriculum, including a 1- to 2-hour online self-study with video and 2.5-hour practicum using silicone models and a trained patient surrogate.


Solitary mass detection: 84% by R1s, 46% by R2s (RR = 1.82, 95%CI = 1.36, 2.43, P < 0.0001). Of those finding a mass, 62% of R1s and 10% of R2s used at least 5 of 8 standardized descriptors (RR = 6.19, 95%CI = 2.06, 18.59, P = 0.001). R1s false positive findings were not statistically different from R2s (P = 0.54). Both the use of VS3PM and total time spent on CBE were independently highly predictive of finding the mass in either group.


Most untrained primary care residents are not proficient in CBE. Standardized VS3PM CBE training improves the ability to detect and describe a small mass in a silicone breast model. Better CBE training for residents may improve the early detection of breast cancer.


breast cancer medical education clinical breast examination early detection 

Copyright information

© Society of General Internal Medicine 2007

Authors and Affiliations

  • Elizabeth Steiner
    • 1
  • Donald F. Austin
    • 1
  • Nancy C. Prouser
    • 1
  1. 1.OHSU Cancer Institute Breast Health Education ProgramOregon Health & Science UniversityPortlandUSA

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