COMPREHENSIVE NEEDS ASSESSMENT OF CLINICAL BREAST EVALUATION SKILLS OF PRIMARY-CARE RESIDENTS

Background: Health care reform places primary care (PC) physicians in an increasingly significant role for breast cancer screening and diagn osis. This study assessed the adequacy of traditional PC resident trai ning to prepare physicians for this front-line role, Methods: Sixty-ei ght primary care residents, representing seven training programs, part icipated in a multidimensional needs assessment study of clinical brea st evaluation skills. Results: Performance deficiencies noted in each component were most significant in (1) common breast problem managemen t (problem-solving mean 44.51 +/- 11.01); (2) breast examination skill s (mean 49.65 +/- 14.48%); and (3) lump detection sensitivity (mean 40 ,20 +/- 17.10%). Overall examination reliability was good (alpha =.82) . Factorial ANOVA revealed significant performance differences among t raining programs. Residency programs with higher performance levels re ported dedicated breast curricula, and residents rated these programs as providing more adequate training. Programs with poorer performance in breast examination lacked curriculum emphasis, with residents descr ibing training received as poor to fair. Conclusion: This study demons trated performance deficits in the clinical breast evaluation skills o f graduating PC residents that have not been captured by traditional e valuation methodologies. This may represent a limitation in the abilit y of many PC physicians to effectively screen and diagnose patients wi th breast cancer.