title: [Assessment of clinical observation skills of last year medical students].
abstract: OBJECTIVE
  Clinical examination skills are poorly evaluated by theoretical tests. We observed the clinical examination of real patients by 6th year medical students.
  
  
  METHODS
  Four internists involved in teaching activities defined 11 clinical examination items, with two objective performance criteria each. The students were evaluated in two internal medicine departments during the rotation preceding or following their national graduation test. Scores by item and by criterion and an overall score were calculated and correlated with their rank at the national graduation test.
  
  
  RESULTS
  Thirty-two students were evaluated in one department and 18 in the other; each evaluation lasted approximately 30 minutes. The results were similar in both departments. Only 2 items got a score over 75% in this students' sample (acute respiratory failure, peripheral pulses); 4 items were satisfied at less than 50% (lymph nodes, right heart failure, liver failure, and attention). The mean overall score was 6.5/11 (standard deviation 1.5). National rankings were good (median 1605/8001, interquartile 453-3036) but uncorrelated with the global score (Spearman coefficient -0.13; P=0.39).
  
  
  CONCLUSIONS
  Bedside evaluation of the students reveals substantial deficiencies, a few months or weeks before taking their position as residents. Several elementary skills are mastered by a minority of them (search for an asterixis, distended jugular veins, deep tendon reflexes), even among those successful at the national graduation test. Bedside evaluation of clinical examination skills should be more systematically performed.
authors.affiliation: Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France; Inserm, U1142, LIMICS, 75006 Paris, France. Electronic address: olivier.steichen@tnn.aphp.fr.
authors.forename: O
authors.initials: O
authors.lastname: Steichen
authors.affiliation: Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France.
authors.forename: S
authors.initials: S
authors.lastname: Georgin-Lavialle
authors.affiliation: Service de médecine interne, hôpital Tenon, 4, rue de la Chine, AP-HP, 75020 Paris, France; Faculté de médecine, Sorbonne universités, UPMC université Paris 06, 75006 Paris, France.
authors.forename: G
authors.initials: G
authors.lastname: Grateau
authors.affiliation: Département de médecine interne, hôpital européen Georges-Pompidou, AP-HP, 75015 Paris, France; Faculté de médecine, université Paris-Descartes, 75006 Paris, France.
authors.forename: B
authors.initials: B
authors.lastname: Ranque
mesh_terms: D002983:Clinical Competence / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate / Q000706:statistics & numerical data; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007388:Internal Medicine / Q000193:education / Q000592:standards; D007396:Internship and Residency / Q000592:standards; D008297:Male; D019370:Observation; D010808:Physical Examination / Q000523:psychology; D013337:Students, Medical / Q000706:statistics & numerical data
keywords: Educational measurement; Enseignement médical; Examen physique; Medical education; Medical students; Physical examination; Symptom assessment; Étudiant en médecine; Évaluation des symptômes; Évaluation éducative