VARIABILITY IN THE CLINICAL SKILLS OF RESIDENTS ENTERING TRAINING-PROGRAMS IN SURGERY

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.