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New U.S. Docs Score Low on Bedside Manner

Technology blamed for lack of personal touch

TUESDAY, Sept. 4, 2001 (HealthDayNews) -- Does the world's most technologically advanced health care system produce the best bedside doctors?

Not right away, a new study suggests.

Medical residents educated in the United States were outscored by their foreign-schooled counterparts in 13 tests of their acuity in physical examinations, the study shows. Experts say the results underscore the way advanced technology can push clinical skills into the shadows early in a doctor's career.

Dr. Eugene Dinkevich, a pediatrician at Downstate Children's Medical Center in Brooklyn, N.Y., and co-author of the study, says the findings should be a "wake-up call" to medical schools about the growing emphasis on technology at the expense of clinical training. "It's certainly something that needs to be addressed," Dinkevich says.

The work was led by Dr. Philip Ozuah, an associate professor of medicine at Albert Einstein College of Medicine in the Bronx, N.Y., and appears as a letter in the Sept. 5 issue of the Journal of the American Medical Association. Ozuah received his medical school education in Nigeria and did his specialized training in the United States. Medical education is one of his specialties.

The researchers compared physical exam skills of 113 U.S.-educated first-year residents in pediatrics and internal medicine -- each of whom had finished in the top quarter of their medical school class -- with those of 35 foreign students who had come to the United States for their residency training.

The test required the fledgling physicians to examine the abdomen of a young adult patient under the supervision of a more senior doctor. It included general inspection and examining by touch in the region to look for signs of enlarged organs.

International students outscored the American-educated residents across the board and regardless of their specialty, the researchers say.

The researchers didn't follow the residents through their training, and Dinkevich says the gap between the foreign- and U.S.-educated doctors probably would disappear over time.

Dr. Salvatore Mangione, an asthma specialist at Thomas Jefferson University in Philadelphia who also has compared the bedside skills of American doctors with their internationally trained counterparts, says he, too, finds the Americans lacking. And he says he's not surprised by the latest findings.

Mangione blames the gap on American medicine's reliance on technology.

"If you have nothing but your stethoscope, you're probably going to rely on it," he says.

Indeed, Mangione has found that British and Canadian doctors -- admittedly far from technology starved -- outperform American-educated physicians in the use of the listening device to pick up heart murmurs and other important chest sounds.

The New York researchers say that, since 1998, all incoming foreign medical residents must pass a test of their physical examination skills, and most say they take courses to prepare for it. U.S. residents, however, have no such requirement.

But Dr. Deborah Danoff, associate vice president of medical education for the Association of American Medical Colleges, says it's hard to extrapolate the skills of all 16,000-plus medical students in the United States from such a small sample.

"This study suggests that there is considerable variability [in examination skills] in a small group of medical students," Danoff says. Since the foreign residents had prepped for the entrance exam, the researchers might simply have been measuring test-taking skills, she adds.

Even so, Danoff says, the findings should be a "reminder to schools to assess [students] in these areas, and that they follow up with residency programs" to track the progress of their graduates.

The National Board of Medical Examiners is now trying to develop a clinical skills exam using standardized "patients" -- actors coached to render a consistent set of symptoms and complaints -- that it hopes will bring "a valuable dimension to the licensure examination" for physicians. The group says it doesn't know yet when such a test might be implemented or at what cost.

A national exam of medical students' clinical proficiency could encounter resistance from schools, which prefer to evaluate their own graduates. Moreover, students feel they're already tested enough. Dinkevich, for one, says he supports such a test, which could be added to the current licensing exam all medical school grads take.

What To Do

To find out more about medical education, check out the Association of American Medical Colleges. For more on medical residencies, try the ResidencySite.

SOURCES: Interviews with Eugene Dinkevich, M.D., assistant professor of pediatrics, State University of New York Downstate Children's Medical Center, New York City; Deborah Danoff, M.D., associate vice president, division of medical education, American Association of Medical Colleges, Washington, D.C.; and Salvatore Mangione, M.D., clinical associate professor of medicine, Thomas Jefferson University, Philadelphia; Sept. 5, 2001 Journal of the American Medical Association
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