Background: Health care reform places primary care (PC) physicians in an increasingly significant role for breast cancer screening and diagnosis. This study assessed the adequacy of traditional PC resident training to prepare physicians for this front-line role.
Methods: Sixty-eight primary care residents, representing seven training programs, participated in a multidimensional needs assessment study of clinical breast evaluation skills.
Results: Performance deficiencies noted in each component were most significant in (1) common breast problem management (problem-solving mean 44.51±11.01); (2) breast examination skills (mean 49.65±14.48%); and (3) lump detection sensitivity (mean 40.20±17.0%). Overall examination reliability was good (α=.82). Factorial ANOVA revealed significant performance differences among training programs. Residency programs with higher performance levels reported dedicated breast curricula, and residents rated these programs as providing more adequate training. Programs with poorer performance in breast examination lacked curriculum emphasis, with residents describing training received as poor to fair.
Conclusion: This study demonstrated performance deficits in the clinical breast evaluation skills of graduating PC residents that have not been captured by traditional evaluation methodologies. This may represent a limitation in the ability of many PC physicians to effectively screen and diagnose patients with breast cancer.
Breast cancer Education Breast evaluation
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Sachdeva A, Loiacono A, Amiel G, Blair P. Variability in the clinical skills of residents entering training programs in surgery.Surgery 1995;118:300–9.PubMedGoogle Scholar
Foley R, Smilansky J, Yonke A. Teacher-student interaction in a medical clerkship.J Med Educ 1979;54:622–6.PubMedGoogle Scholar
DaRosa D, Folse R, Sachdeva A. Description and results of a needs assessment in preparation for the surgeons as educators course.Am J Surg 1995;169:410–3.CrossRefPubMedGoogle Scholar
Messick S. Validity. In: Linn RL, ed.Educational Measurement. New York: Macmillan; 1989:13–103.Google Scholar
Cohen R, Reznick R, Taylor B, Provan J, Rothman A. Reliability and validity of the objective structured clinical examination in assessing surgical residents.Am J Surg 1990;160:302–5.PubMedGoogle Scholar
Petrusa ER, Blackwell TA, Ainsworth MA. Reliability and validity of an objective structured clinical examination for assessing the clinical performance of residents.Arch Intern Med 1990;150:573–7.CrossRefPubMedGoogle Scholar
Cronbach LJ. Coefficient alpha and the internal structure of tests.Psychometrika 1951;26:197–334.Google Scholar
Whitman N: Creative Medical Teaching, University of Utah School of Medicine; 1990:Google Scholar
American College of Surgeons.Surgeons as Educators Manual. Chicago: American College of Surgeons; 1997.Google Scholar
Hall D, Adams C, Stein G, Stephenson H, Goldstein M, Pennypacker H. Improved detection of human breast lesions following experimental training.Cancer 1980;46:408–14.PubMedGoogle Scholar
Baker LH. Breast cancer detection demonstration project: Five-year summary report.CA 1982;32::194–225.PubMedGoogle Scholar
Fletcher S, O'Malley M, Bunce L. Physicians' abilities to detect lumps in silicone breast models.JAMA 1985;253:2224–8.PubMedGoogle Scholar
Ericsson KA, Krampe RT, Tesch-Romer C. The role of deliberate practice in the acquisition of expert performance.Psychological Review 1993;100:363–406.CrossRefGoogle Scholar
Ericsson KA. The acquisition of expert performance: an introduction to some of the issues. In: Ericsson KA, ed.The Road to Excellence: The Acquisition of Expert Performance in the Arts and Sciences, Sports and Games. Mahwah, NJ: Lawrence Erlbaum Associates, 1996:1–50.Google Scholar
Newble D, Swanson DB. Psychometric characteristics of the objective structured clinical examination.Med Educ 1988;22:325–34.PubMedGoogle Scholar
Aloia JF, Jonas E. Skills in history-taking and physical examination.J Med Educ 1976;51:410–5.PubMedGoogle Scholar
Stillman P, Swanson D, Regan MB, et al. Assessment of clinical skills of residents utilizing standardized patients.Ann Int Med 1991;114:393–401.PubMedGoogle Scholar
Sloan DA, Donnelly M, Johnson S, Schwartz R, Strodel W. Use of an objective structured clinical examination (OSCE) to measure improvement in clinical competence during the surgical internship.Surgery 1993;114:343–51.PubMedGoogle Scholar
Sloan DA, Donnelly MB, Schwartz RW. Assessing medical students' and surgery residents' clinical competence in problem solving in surgical oncology.Ann Surg Oncol 1994;1:204–12.PubMedGoogle Scholar
Chalabian J, Garman KA, Wallace P, Dunnington G, Dunnington GL. Clinical breast evaluation skills of house officers and medical students.Am Surg 1996;62:840–5.PubMedGoogle Scholar