"Real world" shortcuts

One of my favorite articles to cite in response to the student who says, "... but my resident is showing me shortcuts for the real world!"

Am Surg 1996 Oct; 62(10):840-5

Clinical breast evaluation skills of house officers and students

Chalabian J, Garman K, Wallace P, Dunnington G

Current health care reform is placing primary care physicians in an increasingly significant role as the front-line providers of women's health care. It is critical that primary care physicians as well as surgeons develop the knowledge base, physical examination skills, and interpersonal skills necessary to care for patients with breast cancer. This study uses a standardized patient breast case in an Objective Structured Clinical Examination (OSCE) format to objectively assess clinical breast evaluation skill performance by house officers and medical students. Performance of USC medical students, exposed to a uniform clinical breast evaluation curriculum, were compared with MSIVs from four other medical schools, and postgraduate year I and II categorical surgical residents. USC medical students were found to maintain performance between an initial surgical OSCE breast station and a delayed clinical practice exam (CPX) reexam as MSIVs (breast exam, P = 0.21; patient-physician interaction, P = 0.67). USC MSIVs had statistically significantly higher performance on the CPX breast station when compared with other MSIVs (T = 11.701, two-tailed test, P = 0.0001). House officers demonstrated significantly poorer skills than medical students (P = 0.03) (My own emphasis added- GJB). An incoming housestaff group showed improvement with clinical breast evaluation checklists and orientation as part of their intern orientation program and ongoing curriculum.

My concluding thoughts: The 'real world' is not wholly divorced from the classroom. The 'real world' is a relentless, practical final exam to which you must bring every resource your instructor has given you, every day of your career.