Clinical examination skills and clinical acumen are fundamental aspects of the medical curriculum. Most medical schools begin teaching clinical examination techniques in the pre-clinical (first and second) years, including both general annual physicals as well as more specialized skills, like the head, eyes, ears, nose, and throat (HEENT) exam.
Anonymous surveys were distributed to rising second, third, and fourth year medical students at the UCLA David Geffen School of Medicine. Students were polled on their preferences for learning fundamental clinical skills, and how often they were able to practice learned techniques. Additionally, a literature review was performed. A 5-point Likert scale was used to assess students’ confidence in their abilities to perform an annual physical exam and a HEENT exam. T-tests were utilized to identify differences between confidence of medical students in their pre-clinical vs clinical years.
57 medical students participated in the survey. Students’ top preferences for learning clinical skills was practicing on their peers (86%), practicing on standardized patients (77%), and examining real patients (63%). 69% of students in their pre-clinical (first and second) years reported utilizing clinical skills on real patients every month or greater, while all third and fourth year students on clinical rotations reported weekly clinical skills practice. Pre-clinical students demonstrated significantly lower confidence in their ability to perform a general physical examination as compared to students in their third and fourth years. There was no significant difference in confidence for the HEENT exam. The most common reported barrier to one’s ability to learn clinical skills was a lack of opportunity to examine real patients in the current medical education curriculum. 93% of students supported more frequent practice on patients in a clinical setting to improve their exposure and skills.
The majority of pre-clinical medical students do not feel confident in their abilities to do a full general physical exam, or a more specific subspecialty HEENT exam. The opportunity to practice learned clinical skills increases over the course of the medical curriculum. Notably, students’ confidence in their technique also increases over time. The results suggest an unmet demand for more dedicated practice time during the first two years of medical education.