Background. Residents may have significant differences in clinical ski
lls at the start of their surgical training. The purpose of this study
was to investigate the variability in these skills by using an object
ive structured clinical examination. Methods. A needs assessment was p
erformed, and an objective structured clinical examination composed of
10, two-part stations was developed. Standardized patients (SPs) were
trained, validated, and used as both simulated patients and evaluator
s to assess history taking, physical examination, and interpersonal sk
ills of 10 firs-year surgical residents. Structured patient notes (PNs
) written by residents after the SP encounters were used to assess his
tory and physical examination documentation skills. Data from one stat
ion were not used because more than 25% of the SP ratings were missing
. Results. The alpha-reliability was 0.78 for SP ratings, 0.91 for PN
scores, and 0.91 for the combined scores. ANOVA revealed significant v
ariation in individual residents' clinical skills as assessed by SPs (
F = 4.56, p < 0.01), PNs (F = 11.09, p < 0.001), or both (F = 10.9, p
< 0.001). Paired t tests showed that residents scored significantly hi
gher on history taking than on physical examination and attained signi
ficantly lower scores on documentation as compared with performance of
both history and physical examination (p < 0.001 for each comparison)
. Conclusions. The results showed significant variability in clinical
skills of the group of residents and yield detailed information on the
performance of each resident. The data were shared with individual re
sidents and are being used to make changes in the educational activiti
es of the program.