Improving residents' performances of clinical breast examination

Clinical breast examination and mammography are recommended as combined modalities for breast cancer screening. Rates of mammography are increasing; however, clinical breast examination rates are decreasing. Specific training in breast examination may be warranted.

The authors developed an ambulatory rotation to teach breast cancer screening to medical residents. To assess whether this training improved screening performance, they compared clinical breast examination and mammography rates in residents' continuity clinics before and after training among residents who were assigned to the training program and residents who were not.

314 women patients were seen by 28 residents. The rates for annual clinical breast examination and mammography were 39% and 71%, respectively. Clinical breast examination rates increased by 18% among the residents assigned to the training program, whereas they dropped by 13% over than same period among the residents who had not received the training (p < 0.005). Female residents performed more clinical breast examinations than did their male counterparts (50% vs 34% p < 0.01). Mammography rates did not change with training, and were not associated with resident gender or career plans.

Although the residents performed mammography at high rates, clinical breast examination rates were low. Short-term directed teaching about clinical breast examination increased the performance of this screening test, and is important to incorporate into teaching programs.