Variability in the clinical skills of residents entering training programs in surgery.
BACKGROUND
Residents may have significant differences in clinical skills at the start of their surgical training. The purpose of this study was to investigate the variability in these skills by using an objective structured clinical examination.


METHODS
A needs assessment was performed, and an objective structured clinical examination composed of 10, two-part stations was developed. Standardized patients (SPs) were trained, validated, and used as both simulated patients and evaluators to assess history taking, physical examination, and interpersonal skills of 10 first-year surgical residents. Structured patient notes (PNs) written by residents after the SP encounters were used to assess history and physical examination documentation skills. Data from one station were not used because more than 25% of the SP ratings were missing.


RESULTS
The alpha-reliability was 0.78 for SP ratings, 0.91 for PN scores, and 0.91 for the combined scores. ANOVA revealed significant variation in individual residents' clinical skills as assessed by SPs (F = 4.56, p < 0.01), PNs (F = 11.09, p < 0.001), or both (F = 10.9, p < 0.001). Paired t tests showed that residents scored significantly higher on history taking than on physical examination and attained significantly lower scores on documentation as compared with performance of both history and physical examination (p < 0.001 for each comparison).


CONCLUSIONS
The results showed significant variability in clinical skills of the group of residents and yielded detailed information on the performance of each resident. The data were shared with individual residents and are being used to make changes in the educational activities of the program.
Sachdeva
A K
AK
Department of Surgery, Medical College of Pennsylvania, Philadelphia 19129, USA.
Loiacono
L A
LA
Amiel
G E
GE
Blair
P G
PG
Friedman
M
M
Roslyn
J J
JJ
D002983:Clinical Competence; D013502:General Surgery / Q000193:education*; D007396:Internship and Residency; D008499:Medical Records; D010808:Physical Examination