title: Performance in physical examination on the USMLE Step 2 Clinical Skills examination.
abstract: OBJECTIVE
  To provide descriptive information about history-taking (HX) and physical examination (PE) performance for U.S. medical students as documented by standardized patients (SPs) during the Step 2 Clinical Skills (CS) component of the United States Medical Licensing Examination. The authors examined two hypotheses: (1) Students perform worse in PE compared with HX, and (2) for PE, students perform worse in the musculoskeletal system and neurology compared with other clinical domains.
  
  
  METHODS
  The sample included 121,767 student-SP encounters based on 29,442 examinees from U.S. medical schools who took Step 2 CS for the first time in 2011. The encounters comprised 107 clinical presentations, each categorized into one of five clinical domains: cardiovascular, gastrointestinal, musculoskeletal, neurological, and respiratory. The authors compared mean percent-correct scores for HX and PE via a one-tailed paired-samples t test and examined mean score differences by clinical domain using analysis of variance techniques.
  
  
  RESULTS
  Average PE scores (59.6%) were significantly lower than average HX scores (78.1%). The range of scores for PE (51.4%-72.7%) was larger than for HX (74.4%-81.0%), and the standard deviation for PE scores (28.3) was twice as large as the HX standard deviation (14.7). PE performance was significantly weaker for musculoskeletal and neurological encounters compared with other encounters.
  
  
  CONCLUSIONS
  U.S. medical students perform worse on PE than HX; PE performance was weakest in musculoskeletal and neurology clinical domains. Findings may reflect imbalances in U.S. medical education, but more research is needed to fully understand the relationships among PE instruction, assessment, and proficiency.
authors.affiliation: Dr. Peitzman was, at the time of this study, senior medical advisor, Clinical Skills Evaluation Collaboration, a group comprising National Board of Medical Examiners and Educational Commission for Foreign Medical Graduates staff. He is currently professor of medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania. Ms. Cuddy is measurement scientist, National Board of Medical Examiners, Philadelphia, Pennsylvania.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Peitzman
authors.forename: Monica M
authors.initials: MM
authors.lastname: Cuddy
mesh_terms: D002983:Clinical Competence; D004501:Education, Medical; D006801:Humans; D008007:Licensure, Medical; D008487:Medical History Taking; D016544:Patient Simulation; D010808:Physical Examination; D014481:United States