Objective: 
Competency in basic history and physical examination (H&P) skills is essential for medical students, yet their early training in this area is not always adequate.  Student feedback has suggested a greater awareness of the importance of these skills when they have been emphasized by faculty and when examinations have been introduced, such as the NBME Clinical Skills examination.   The study goal is to evaluate H&P skills among second year students (MS-2).  

Methods: 
Beginning in 2001, all MS-2 were evaluated on their performance of a complete, head-to-toe SP H&P, after their Clinical Skills Course (CSC).  After the first year, subsequent classes were briefed by the faculty on the level of performance of the prior year’s students and encouraged to commit more effort in this domain. The CSC curriculum was otherwise unchanged for the three years observed.  In 2004, an additional identical SP experience was added to the CSC as a midterm examination, and the post-CSC H&P was adopted as the course’s final examination.  Students received formative feedback on their performance on the midterm prior to the final H&P.

Results: 

Average scores were: 2001 ­ 75%; 2002 ­ 79%; 2003 -- 86% (sd=8 for all years).  Students scoring below the “passing" score of 80% steadily declined:  2001 ­ 66% “fail”; 2002 ­ 43%; 2003 ­ only 21% “fail”. 

Conclusion: 
Initial (2001) H&P results showed lower than desired competency levels.  During the three years, there were no changes in the CSC curriculum.  The steady increase in overall performance for each class suggests that some factor influenced the entire group.   One explanation is that the faculty’s higher perceived expectations and encouragement led to higher performance.  Student awareness of the upcoming NMBE Clinical Skills exam also rose during this interval.  Adding a single post-course performance-based assessment appears to have had a significantly positive effect on H&P skills even with no other curricular changes.