title: Self-confidence in and perceived utility of the physical examination: a comparison of medical students, residents, and faculty internists.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  Cross-sectional survey of third- and fourth-year medical students, Internal Medicine residents, and faculty Internists at an academic teaching hospital.
  
  
  METHODS
  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.
authors.affiliation: Division of General Internal Medicine, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, USA. edward_wu@post.harvard.edu
authors.forename: Edward H
authors.initials: EH
authors.lastname: Wu
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Fagan
authors.forename: Steven E
authors.initials: SE
authors.lastname: Reinert
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Diaz
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004501:Education, Medical; D004521:Educational Measurement; D005180:Faculty, Medical; D005260:Female; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000379:methods; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010808:Physical Examination / Q000379:methods*; D020377:Self Efficacy; D013337:Students, Medical / Q000523:psychology*