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Acad Med. 2008 Jan;83(1):96-9.

When should students learn essential physical examination skills? Views of internal medicine clerkship directors in North America.

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University of Virginia, Department of Medicine, Charlottesville, Virginia 22908, USA.



To determine whether any consensus exists among internal medicine clerkship directors regarding when students should acquire proficiency in selected physical examination (PE) skills.


In 2004, the annual survey of Clerkship Directors in Internal Medicine (CDIM) included a question about the timing of PE-skills proficiency. (CDIM members are from 123 U.S. and Canadian medical schools.) A total of 259 members (123 institutional and 136 individual members) were asked the following question about 39 common physical examination skills, selected using a consensus process among the authors and members of the CDIM Council: "When in the medical school curriculum should medical students acquire proficiency for the following skills?"


There were 157 respondents, an overall response rate of 60%. There were 89 (72%) responding institutional members and 68 (50%) responding individual members. Respondents agreed that 31 (80%) of the skills should be learned by the end of the clerkship year. However, considerable variability existed regarding when in the curriculum those skills should be learned: for only 18 of 39 skills was there 80% agreement on skills-learning timing. CDIM members were divided on whether normal examination findings should be learned before or during the clerkships.


Variability existed among CDIM members regarding their expectations for the timing of student physical examination learning in the undergraduate medical curriculum. Creating a common vision among clerkship directors and faculty regarding what neophyte clinicians must learn to do and when they are expected to be able to do it will help to address the issue of physical examination proficiency standards of medical students.

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