Defects in postgraduate clinical skills as revealed by the objective structured long examination record (OSLER)

It is a frequent observation by experienced clinicians that the standard of clinical skills of medical graduates is defective. To support or refute this view, the performance of 164 doctors preparing for the Part II of the medical membership was measured in the long case examination by using the objective structured long examination record (OSLER). This assessment method includes presentation of history (four items), physical examination (three items), investigations, management and diagnostic acumen. Performance on each of the items was measured as P+ (very good/excellent), P (pass/bare pass) and P- (below pass). For the four items on presentation of history the average number of doctors obtaining a P+ grade was 32 (22%), the average for a P- grade was 44 (28%). In the physical examination section 12 (7%) obtained P+ for examination technique and 64 (39%) P-. On the ability to establish physical signs, 17 (10%) obtained P+ and 65 (40%) P-. With regard to investigations and management, 20 (12%) obtained P+ in each and 47 (29%) and 42 (26%) obtained P- respectively. For diagnostic acumen 15 (9%) obtained P+ and 75 (46%) P-. In the light of these findings it is concluded that the designers of Undergraduate and Postgraduate clinical teaching should review their teaching methods.