Introduction to clinical medicine: A time for consensus and integration

      Most physicians and medical educators would agree that basic clinical skills are critical to physician medical decision-making. However, even with initiation of the United States Medical Licensing Exam (USMLE) Step 2 Clinical Skills Examination in 2004, there is little spoken consensus or dialogue among medical schools concerning the delivery of curriculum on clinical skills, the existence of agreed upon standards, or even organized discussion about standards.
      • Papadakis M.A.
      The step 2 clinical-skills examination.
      The manner in which medical students learn clinical skills is widely varied, and the acquisition of the skills is evaluated in a variety of ways, from written and multiple-choice exams to standardized patient/simulation-based performance exams. This commentary provides background information about the current status of clinical skills courses in U.S. medical schools, and proposes that the time has come for greater consensus on the clinical skills curriculum across medical schools, integration and collaboration of the curriculum with the basic science courses as well as the clinical clerkships within medical schools, and meaningful outcome measures to determine success in meeting these goals.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The American Journal of Medicine
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Papadakis M.A.
        The step 2 clinical-skills examination.
        NEJM. 2004; 350: 1703-1705
        • Windish D.M.
        • Paulman P.M.
        • Goroll A.H.
        • Bass E.B.
        Do clerkship directors think medical students are prepared for the clerkship years?.
        Acad Med. 2004; 79: 56-61
        • Novack D.H.
        • Volk G.
        • Drossman D.A.
        • Lipkin M.
        Medical interviewing and interpersonal skills teaching in US medical schools.
        JAMA. 1993; 269: 2101-2105
        • Clerkship Directors in Internal Medicine
        2003 CDIM Survey. Clerkship Directors in Internal Medicine, Washington, D.C2003
        • Hampton J.R.
        • Harrison M.J.G.
        • Mitchell J.R.A.
        • Prichard J.S.
        • Seymour C.
        Relative contributions of history-taking, physical examination, and laboratory investigation to diagnosis and management of medical outpatients.
        BMJ. 1975; 2: 486-489
        • Peterson M.C.
        • Holbrook J.H.
        • Hales D.V.
        • Smith N.L.
        • Staker L.V.
        Contributions of the history, physical examination, and laboratory investigation in making medical diagnoses.
        West J Med. 1992; 156: 163-165
        • Kern D.C.
        • Parrino T.A.
        • Korst D.R.
        The lasting value of clinical skills.
        JAMA. 1985; 254: 70-76
        • Pfeiffer C.
        • Madray H.
        • Ardolino A.
        • Willm J.
        The rise and fall of students’ skill in obtaining a medical history.
        Med Educ. 1998; 32: 283-288
        • Mangione S.
        • Nieman L.Z.
        • Gracely E.
        • Kaye D.
        The teaching and practice of cardiac auscultation during internal medicine and cardiology training.
        Ann Intern Med. 1993; 119: 47-54
        • Haist S.A.
        • Wilson J.F.
        • Brigham N.L.
        • Fosson S.E.
        • Blue A.V.
        Comparing fourth-year medical students with faculty in the teaching of physical examination skills to first-year students.
        Acad Med. 1998; 73: 198-200
        • Stillman P.L.
        • Ruggill J.S.
        • Sabers D.
        The use of practical instructors to evaluate a complete physical examination.
        Eval Health Professions. 1978; 1: 49-54
        • Seegal D.
        • Wertheim A.R.
        On the failure to supervise students’ performance of complete physical examinations.
        JAMA. 1962; 180: 476-477
        • Wiener S.
        • Nathanson M.
        Physical examination.
        JAMA. 1976; 236: 852-855
        • Wray N.P.
        • Friedland J.A.
        Detection and correction of house staff error in physical diagnosis.
        JAMA. 1983; 249: 1035-1037
        • Karnath B.
        • Thornton W.
        • Frye A.W.
        Teaching and testing physical examination skills without the use of patients.
        Acad Med. 2002; 77: 753
        • Smith M.A.
        • Gertler T.
        • Freeman K.
        Medical students’ perceptions of their housestaffs’ ability to teach physical examination skills.
        Acad Med. 2003; 78: 80-83
        • Remmen R.
        • Derese A.
        • Scherpbier A.
        • Denekens J.
        • Hermann I.
        • van der Vleuten C.
        • Royen P.V.
        • Bossaert L.
        Can medical schools rely on clerkships to train students in basic clinical skills?.
        Med Educ. 1999; 33: 600-605
        • Stillman P.L.
        • Regan M.B.
        • Swanson D.B.
        • Case S.
        • McCahan J.
        • Feinblatt J.
        • Smith S.R.
        • Willms J.
        • Nelson D.V.
        An assessment of the clinical skills of fourth-year students at four New England medical schools.
        Acad Med. 1990; 65: 320-326
        • Holmboe E.S.
        • Hawkins R.E.
        • Huot S.J.
        Effects of training in direct observation of medical residents’ clinical competence.
        Ann Intern Med. 2004; 140: 874-881
        • Pangaro L.
        A new vocabulary and other innovations for improving descriptive in-training evaluations.
        Acad Med. 1999; 74: 1203-1207
        • Kalet A.
        • Earp J.A.
        • Kowlowitz V.
        How well do faculty evaluate the interviewing skills of medical students?.
        JGIM. 1992; 7: 499-505
        • Cooper C.
        • Mira M.
        Who should assess medical students’ communication skills.
        Med Educ. 1998; 32: 419-421
        • Vannatta J.B.
        • Smith K.R.
        • Crandall S.
        • Fischer P.C.
        • Williams K.
        Comparison of standardized patients and faculty in teaching medical interviewing.
        Acad Med. 1996; 71: 1360-1362
        • Martin I.G.
        • Jolly B.
        Predictive validity and estimated cut score of an objective structured clinical examination (OSCE) used as an assessment of clinical skills at the end of the first clinical year.
        Med Educ. 2002; 36: 418-425
        • Mavis B.E.
        • Henry R.C.
        Between a rock and a hard place.
        Med Educ. 2002; 36: 408-409
        • Jolly B.C.
        • Jones A.
        • Dacre J.E.
        • Elzubier M.
        • Kopelman P.
        • Hitman G.
        Relationships between students’ clinical experiences in introductory clinical courses and their performances on an objective structured clinical examination (OSCE).
        Acad Med. 1996; 71: 909-916
        • Anderson R.C.
        • Fagan M.J.
        • Sebastian J.
        Teaching students the art and science of physical diagnosis.
        Am J Med. 2001; 110: 419-423
        • Miller G.E.
        The assessment of clinical skills/competence/performance.
        Acad Med. 1990; 65: S63-S67