Do clinical breast examination skills improve during medical school?
OBJECTIVE
To assess the effects of stage of training, gender, and specialty interest on medical students' breast cancer knowledge, attitudes, and clinical breast examination (CBE) skills as a case study of the progression of physical examination skills during medical education.


METHODS
In 1996, questionnaires assessing breast cancer knowledge and attitudes were administered to 493 premedical and first-, second-, and third-year medical students at Northwestern University Medical School. Silicone breast models were used to evaluate the CBE proficiency of a subset of 151 students.


RESULTS
Breast cancer knowledge was positively correlated with stage of training (r = .62), with significant differences between all levels (p < .001). In contrast, first-year medical students attained the highest mean lump-detection sensitivity (61.5%), followed by second-year (53.9%) and third-year (43.5%) students (p < .001, first- vs third-year students; p < .10, second- vs third-year students). There was no significant difference in specificity among the four stages.


CONCLUSIONS
The results suggest that breast cancer knowledge and attitudes are not related to CBE proficiency, which is a practiced tactile skill. The decline in lump-detection sensitivity with increased stage of training may demonstrate the need for increased attention to palpation skills during the clinical years. These findings are consistent with those of earlier reports that suggest the need for the reinforcement of physical examination skills during clinical education.
Institute for Health Sciences Research and Policy Studies, Northwestern University Medical School, Chicago, Illinois 60611, USA.
K C
KC
Lee
D
D
Dunlop
N C
NC
Dolan
D001943:Breast Neoplasms / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008953:Models, Anatomic; D010173:Palpation / Q000592:standards*; D012680:Sensitivity and Specificity; D013337:Students, Medical; D011795:Surveys and Questionnaires