Evaluation of pelvic and breast examination skills of interns in obstetrics and gynecology and internal medicine Lorraine Dugoff, MD, a Mauritha R. Everett, RN, BSN, b Louis Vontver, MD, c and Gwyn E. Barley, PhD b Denver, Colo, and Seattle, Wash OBJECTIVE: The purpose of this study was to evaluate the pelvic and breast examination skills of a group of interns who were entering obstetrics and gynecology and internal medicine and to determine whether previous experience predicts performance. STUDY DESIGN: This was a prospective study that, with the use of an examination with a standardized format of 26 skills, assessed the performance of 10 interns who were entering internal medicine and 9 interns who were entering obstetrics and gynecology. v 2 analysis and Fisher exact tests were used. RESULTS: There was no significant difference in overall performance on the pelvic and breast examinations between the two groups. The obstetrics and gynecology interns performed significantly better (P < .05) on the three skills that assessed professional conduct. There was considerable variability within each group. There was no correlation between previous clinical experience and performance on the skills assessment, nor was there a correlation between perceived competence and actual performance. CONCLUSIONS: Previous clinical experience does not predict performance in a standardized assessment of pelvic and breast examination skills nor does it account for the great variability in competence levels in interns who are entering obstetrics and gynecology and internal medicine. (Am J Obstet Gynecol 2003;189:655-8.) Key words: Pelvic examination, breast examination, clinical skills assessment There has been little research on the instruction and evaluation of clinical examination skills in the training of residents in all specialties. In a standardized clinical skills examination, it has been demonstrated that surgical residents have important deficits in patient interaction and problem solving as relates to women’s health. 1 In many residency programs breast and pelvic examination skills are taught by physicians on a live model patient or a gynecologic teaching associate (GTA). For example, at the University of Colorado as part of the orientation, obstetrics and gynecology interns are taught these skills with the use of GTAs. In other institutions, all of the initial training is obtained while examining actual patients under the supervision of a preceptor. In many cases, the interns go on to perform these basic examinations with- out further supervision or direct feedback. Objective structured clinical examinations (OSCEs) have been used successfully as a teaching tool in many fields for the evaluation of clinical competence. 2,3 This type of clinical examination has been used to evaluate physical examination and interpersonal skills in the training of medical students and residents 4-9 ; however, to our knowledge, these techniques have not been used widely in the evaluation of obstetrics and gynecology residents. We previously developed and described a clinical skills assessment to evaluate pelvic and breast examination skills in a group of 113 third-year medical students. 10 The current project was designed to evaluate similar skills of entering interns at the University of Colorado Health Sciences Center. We evaluated interns in both internal medicine and obstetrics and gynecology and hypothe- sized that the entering obstetrics and gynecology interns would perform better than those entering internal medi- cine. We further hypothesized that this difference would be attributable, at least in part, to the extent of the previous experience of the entering interns. Material and methods We developed and implemented a GTA program at the University of Colorado Health Sciences Center in September 2000 as a training method for medical stu- dents. This course was used as part of the third-year student orientation at the beginning of their required From the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, a and the Center for Studies in Clinical Excellence, b University of Colorado Health Sciences Center, and the Department of Obstetrics and Gynecology, University of Washington. c Supported by a grant from Solvay Pharmaceuticals. This article was developed as part of the 2002-2003 APGO/Solvay Pharmaceuticals Educational Scholars Development Program. Presented at the Annual Meeting of CREOG/APGO, Anaheim, Calif, March 1-4, 2003. Reprint requests: Lorraine Dugoff, MD, Box B198, 4200 East Ninth Ave, Denver, CO 80262. E-mail: Lorraine.Dugoff@uchsc.edu Ó 2003, Mosby, Inc. All rights reserved. 0002-9378/2003 $30.00 + 0 doi:10.1067/S0002-9378(03)00892-5 655