DO CLINICAL BREAST EXAMINATION SKILLS IMPROVE DURING MEDICAL-SCHOOL

Purpose. To assess the effects of stage of training, gender, and speci alty interest on medical students' breast cancer knowledge, attitudes, and clinical breast examination (CBE) skills as a case study of the p rogression of physical examination skills during medical education. Me thod. In 1996, questionnaires assessing breast cancer knowledge and at titudes were administered to 493 premedical and first, second, and thi rd-year medical students at Northwestern University Medical School. Si licone breast models were used to evaluate the CBE proficiency of a su bset of 151 students. Results. Breast cancer knowledge was positively correlated with stage of training (r = .62), with significant differen ces between all levels (p < .001). In contrast, first-year medical stu dents attained the highest mean lump-detection sensitivity (61.5%), fo llowed by second-year (53.9%) and third-year (43.5%) students (p < .00 1, first- vs third-year students; p < .10, second- vs third-year stude nts). There was no significant difference in specificity among the fou r stages. Conclusions. The results suggest that breast cancer knowledg e and attitudes are not related to CBE proficiency, which is a practic ed tactile skill. The decline in lump-detection sensitivity with incre ased stage of training may demonstrate the need for increased attentio n to palpation skills during the clinical years. These findings are co nsistent with those of earlier reports that suggest the need for the r einforcement of physical examination skills during clinical education.