Residents' breast examination performance. How often? How well?

The American Cancer Society recommends annual clinical breast examination (CBE) for women with average risk of breast cancer beginning at age 40. The purpose of the current chart review study was to determine the adequacy of CBE performed by house officers in a community teaching hospital. A chart audit of 92 women aged 50 or older who were consecutively admitted to the medical service was used as a baseline measure of CBE documentation. Two subsequent series of 100 women each were evaluated. The first series, which also involved women admitted to the medical service, followed increased emphasis on the importance of CBE during twice daily conferences with supervisor staff. The second series involved women admitted to the obstetrics/gynecology service. In that series, house staff used two history/physical examination forms: one with a slot dedicated to CBE and one without a dedicated slot. Results indicate that supervisors' stressing the importance of CBE resulted in only slight improvement in house officers' performance, even in the presence of risk factors for breast cancer. In the third chart audit, CBE was documented by 88% of house staff who used a form with a dedicated slot for CBE; there were no CBE documentations among staff who used a form without a dedicated slot. The dedicated form was more successful in increasing CBE performance and documentation than verbal emphasis about the importance of breast cancer screening.