It is presumed that graduating medical students possess adequate physical examination skills, although they are rarely evaluated during the clinical years. In this study we assessed the physical examination skills of third-year medical students at the beginning and end of a surgical clerkship and investigated the effect of clerkship experiences and formal feedback on maturation of these skills. Sixty-seven third-year students completed a course on physical examination during their second year of medical school and achieved a 90% performance level on a physical examination performed on a patient instructor. This group subsequently performed a focused physical examination (chest, abdomen, groin [hernia], and external genitalia) during Week 1 and Week 6 of a 6-week third-year surgical clerkship. The physical examination was observed and evaluated using a 38-item checklist; feedback was provided immediately after the first examination. Pretest performance was significantly poorer than that achieved in the second-year course. Statistically significant improvement was noted from pretest to posttest for all areas except the external genitalia examination. Students in later rotations in the academic year did not perform significantly better than students in early rotations. We concluded that deterioration of learned physical examination skills occurs from the preclinical to the clinical years and that this deficiency is not corrected by clerkship experiences. Evaluation and feedback during the clerkship resulted in improvements in skills back to the levels demonstrated during the second year.
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