SELF-CONFIDENCE IN AND PERCEIVED UTILITY OF THE PHYSICAL EXAMINATION: A COMPARISON OF MEDICAL STUDENTS, INTERNAL MEDICINE RESIDENTS, AND FACULTY INTERNISTS
Wu, E H
BACKGROUND: Little is known about how confident medical students, residents, and practicing internists are in their ability to perform specific components of the physical examination, or about the perceived utility of these components in generating clinically important information. METHODS: Based on JAMAs Rational Clinical Examination series, we developed a questionnaire concerning 14 components of the physical examination. Using a Likerttype scale, respondents were asked to indicate how confident (1=Not at all Confident, to 5=Very Confident) they were in their overall physical examination skill, as well as in their ability to perform each skill, and how useful (1 =Not at all Useful, to 5=Very Useful) they felt the overall physical examination, and each skill, to be for yielding clinically important information. Relationships between self-confidence scores and training level were assessed using the Spearman rank correlation. Differences in self-confidence scores among the training levels were determined using oneway analysis of variance (ANOVA) with Scheffe’s multiple comparison test.
RESULTS: The overall response rate was 80% (302/ 376), including 66 3rd-year medical students, 68 4th-year medical students, 48 PGY-I residents, 82 PGY-2 through PGY-4 residents, and 38 general internal medicine faculty.
Of the 14 physical examination skills, measuring blood pressure had the highest mean self-confidence (4.65) and perceived utility (4.88) scores. The fundoscopic exam yielded the lowest mean self-confidence (2.51), while detecting clubbing had the lowest mean perceived utility (3.50). The physical examination skills with the greatest differences between mean self-confidence and perceived utility were distinguishing between a mole and melanoma, detecting a thyroid nodule, and interpreting a diastolic murmur. There was a statistically significant correlation between mean overall self-confidence score and training level (r^sub s^=0.20, p=0.0005), and similar correlations were exhibited for most individual skills. While 4th-year medical students had significantly greater overall confidence than 3rd -year medical students (mean score 3.62 vs. 3.32, p=0.002), PGY-1 residents did not have significantly higher overall confidence than 3ld-year students (mean score 3.50 vs. 3.32, p=0.950).
CONCLUSION: PGY-1 residents did not have greater physical diagnosis self-confidence than 3rd-year medical students. The differences we found between perceived utility and self-confidence for a number of basic physical examination skills suggest potential areas for educational interventions
Copyright Rhode Island Medical Society Dec 2004
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