Can practicing physicians improve their counseling and physical examination skills in breast cancer screening? A feasibility study

Mary E. Costanza, University of Massachusetts Medical School
H. L. Greene Jr.
D. McManus
N. E. Hoople
R. S. Barth

Document Type Article


OBJECTIVE. To improve breast cancer screening skills, practicing non-academic primary care physicians were offered an opportunity to participate in a one-hour private skills-assessment session with a patient instructor. Research questions included: would physicians in non-academic practice be interested in a skills course; would the course improve their skills in breast examination and/or in counseling for mammography; and if they did improve, would the effect endure?

DESIGN. Pilot study with cohort follow-up.

INTERVENTIONS. Physicians were offered an opportunity to have their counseling and physical examination skills evaluated in a one-on-one interaction with standardized patients. The protocol included patient instructors who were trained to use a uniform breast health history that emphasized their increased risk of breast cancer, scant knowledge of breast-cancer screening, and fear of medical tests and cancer. The standardized patients were trained using a 77-point checklist. They demonstrated a high degree of consistency and reproducibility. A critical part of the learning experience was immediate feedback to the physicians regarding their performances. Physicians who took the course were given an opportunity to repeat it approximately 18 months later.

MEASUREMENTS AND MAIN RESULTS. Of the 82 primary care physicians in the community, 49 (60%) were eligible to have their skills evaluated. Of these, 38 (77.6%) participated in the intervention. Baseline skills had mean scores (correct responses) better than 50% in most aspects of the physical examination but less than 35% in several critical counseling areas: reviewing mechanics of getting mammography, actually recommending mammography, and directing the patient regarding scheduling. Of the 38 physicians, 15 repeated the course. There was a significant improvement in their overall performance: 49% vs 67% (p = 0.002).

CONCLUSIONS. Primary care physicians in a non-academic practice are interested in reviewing and improving their counseling skills. They are capable of improving their skills after receiving background information, instruction, and brief feedback. They maintain these improvements over time.