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Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency.

ABSTRACT: Develop new performance evaluation standards for the clinical breast examination (CBE).There are several, technical aspects of a proper CBE. Our recent work discovered a significant, linear relationship between palpation force and CBE accuracy. This article investigates the relationship between other technical aspects of the CBE and accuracy.This performance assessment study involved data collection from physicians (n = 553) attending 3 different clinical meetings between 2013 and 2014: American Society of Breast Surgeons, American Academy of Family Physicians, and American College of Obstetricians and Gynecologists. Four, previously validated, sensor-enabled breast models were used for clinical skills assessment. Models A and B had solitary, superficial, 2?cm and 1?cm soft masses, respectively. Models C and D had solitary, deep, 2?cm hard and moderately firm masses, respectively. Finger movements (search technique) from 1137 CBE video recordings were independently classified by 2 observers. Final classifications were compared with CBE accuracy.Accuracy rates were model A = 99.6%, model B = 89.7%, model C = 75%, and model D = 60%. Final classification categories for search technique included rubbing movement, vertical movement, piano fingers, and other. Interrater reliability was (k = 0.79). Rubbing movement was 4 times more likely to yield an accurate assessment (odds ratio 3.81, P < 0.001) compared with vertical movement and piano fingers. Piano fingers had the highest failure rate (36.5%). Regression analysis of search pattern, search technique, palpation force, examination time, and 6 demographic variables, revealed that search technique independently and significantly affected CBE accuracy (P < 0.001).Our results support measurement and classification of CBE techniques and provide the foundation for a new paradigm in teaching and assessing hands-on clinical skills. The newly described piano fingers palpation technique was noted to have unusually high failure rates. Medical educators should be aware of the potential differences in effectiveness for various CBE techniques.

SUBMITTER: Laufer S

PROVIDER: S-EPMC5360550 | biostudies-literature | 2017 Dec

REPOSITORIES: biostudies-literature

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Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency.

Laufer Shlomi S D'Angelo Anne-Lise D AD Kwan Calvin C Ray Rebbeca D RD Yudkowsky Rachel R Boulet John R JR McGaghie William C WC Pugh Carla M CM

Annals of surgery 20171201 6

<h4>Objective</h4>Develop new performance evaluation standards for the clinical breast examination (CBE).<h4>Summary background data</h4>There are several, technical aspects of a proper CBE. Our recent work discovered a significant, linear relationship between palpation force and CBE accuracy. This article investigates the relationship between other technical aspects of the CBE and accuracy.<h4>Methods</h4>This performance assessment study involved data collection from physicians (n = 553) atten ...[more]

PMID: 27655241

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Project description:Background To ascertain if undergraduate medical students attain adequate knowledge to practice in paediatrics, we designed the minimum accepted competency (MAC) examination. This was a set of MCQ’s designed to test the most basic, ‘must know’ knowledge as determined by non-faculty paediatric clinicians. Only two-thirds of undergraduate students passed this exam, despite 96% of the same cohort passing their official university paediatric examination. We aim to describe the psychometric properties of the MAC examination to explore why there was a difference in student performance between these two assessments which should, in theory, be testing the same subject area. We will also investigate if the MAC examination is a potentially reliable method of assessing undergraduate knowledge. Methods The MAC examination was sat by three groups of undergraduate medical students and paediatric trainee doctors. Test item analysis was performed using facility index, discrimination index and Cronbach’s alpha. Results Test item difficulty on the MAC between each group was positively correlated. Correlation of item difficulty with the standard set for each item showed a statistically significant positive relationship. However, for 10 of the items, the mean score achieved by the candidates did not even reach two standard deviations below the standard set by the faculty. Medical students outperformed the trainee doctors on three items. 18 of 30 items achieved a discrimination index > 0.2. Cronbach’s alpha ranged from 0.22–0.59. Conclusion Despite faculty correctly judging that this would be a difficult paper for the candidates, there were a significant number of items on which students performed particularly badly. It is possible that the clinical emphasis in these non-faculty derived questions was juxtaposed with the factual recall often required for university examinations. The MAC examination highlights the difference in the level of knowledge expected of a junior doctor starting work in paediatrics between faculty and non-faculty clinicians and can identify gaps between the current curriculum and the ‘hidden curriculum’ required for real world clinical practice. The faculty comprises physicians in employment by the University whose role it is to design the paediatric curriculum and deliver teaching to undergraduate students. Non-faculty clinicians are paediatric physicians who work soley as clinicians with no affiliation to an educational institution. The concept of a MAC examination to test basic medical knowledge is feasible and the study presented is an encouraging first step towards this method of assessment. Supplementary information The online version contains supplementary material available at 10.1186/s12909-022-03475-8.

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Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency.

Publications

Rescuing the Clinical Breast Examination: Advances in Classifying Technique and Assessing Physician Competency.

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