CLINICAL COMPETENCE

Medical Educators have recently given indications that all may not be well with the diagnostic abilities of a significant proportion of licensed physicians in postgraduate training. Three studies assessed the clinical ability of qualified physicians to recognise heart abnormalities.

In one US study, only half the house-staff training in cardiology correctly identified 3 classical heart-valve abnormalities[1]. The teachers proposed that focused attention to the learning of specific skills might be expected to correct the deficits.

PRACTICE POINT

Dependence on technological advances may be serious eroding some of the clinical diagnostic skills of younger physicians

In a later study[2], the recommended remedial teaching on a simulator failed to show a significant benefit, and again less than two-thirds of the cardiology interns tested correctly identified the same abnormalities.

At another US centre, internal medicine and family practice residents performed no better than medical students in identifying 12 important and commonly-occurring cardiac events[3]: on average, both the groups of physicians in supervised practice correctly diagnosed only 20% of the abnormalities.

In a fourth study[4] at a third US centre, medical students and licensed physicians at varying stages of training were examined in their clinical ability to detect mild jaundice. Although medical students more commonly diagnosed jaundice when it was not present, increasing levels of training and experience did not improve the inability of one-third of the physicians to identify the sign correctly.

PRACTICE POINT

Significant numbers of licensed physicians may be unable to detect some common physical signs