Assessing physical examination skills of senior medical students: Knowing how versus knowing when

Purpose. Literature has documented a lack of physical examination proficiency among medical students. To investigate UCLA medical students' physical examination proficiency, this study compared their performance on a multiple-station Clinical Performance Examination (CPX) focused on clinical cases with that on a thorough physical examination objective structured clinical examination (OSCE) of the same organ systems. Method. One hundred sixty-three beginning fourth-year students participated in the study. Four organ systems were included in both the CPX and OSCE. Pearson's correlation coefficients and paired-sample t-tests were conducted to determine the correlations between and differences in the two tests. Results. The physical examination scores on the CPX were significantly (P < .001) lower both by organ subscale and in total than those on the OSCE. Correlation coefficients between the two tests were negligible. Conclusions. The study suggests that fourth-year medical students may demonstrate competency in directed examination of organ systems while being unable to correctly apply those examination skills to the work-up of clinical cases.