Comprehensive needs assessment of clinical breast evaluation skills of primary care residents.

Overview

BACKGROUND: Health care reform places primary care (PC) physicians in an increasingly significant role for breast cancer screening and diagnosis. This study assessed the adequacy of traditional PC resident training to prepare physicians for this front-line role. METHODS: Sixty-eight primary care residents, representing seven training programs, participated in a multidimensional needs assessment study of clinical breast evaluation skills. RESULTS: Performance deficiencies noted in each component were most significant in (1) common breast problem management (problem-solving mean 44.51 +/- 11.01); (2) breast examination skills (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 training programs. Residency programs with higher performance levels reported 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 describing training received as poor to fair. CONCLUSION: This study demonstrated performance deficits in the clinical breast evaluation skills of graduating PC residents that have not been captured by traditional evaluation methodologies. This may represent a limitation in the ability of many PC physicians to effectively screen and diagnose patients with breast cancer.