The challenge of clinical interviewing and physical examination performance for general practitioners in Turkey.

BACKGROUND AND OBJECTIVES: This study's objective was to better understand the current conditions and style of practice of generalist physicians in Turkey on clinical interviewing and physical examination skills prior to the widespread availability of family medicine postgraduate training. METHODS: This study was performed in 30 primary health centers, randomly chosen from the 110 primary health centers in Izmir, Turkey. We administered a questionnaire to 106 physicians in those centers, asking about their performance during medical encounters. We then observed 166 first-visit encounters of 37 of those physicians. Finally, we compared physicians' reported behavior (as described in the questionnaires) with their actual performance (when observed). RESULTS: In the physician questionnaire, 86.8% of participants agreed that 20 minutes or more was sufficient time for first visits, but in practice, 81.9% of the interviews lasted less than 5 minutes. The major reason cited by physicians for short interview times was overcrowding (72.6%). In 94.6% of the encounters, physicians obtained the history of present illness but the rest of the history, such as past history and family history, was gathered in less than 40% of the interviews. Except for the examination of oral cavity and pharynx, lungs, and heart, almost all the rest of the physical examination was performed in less than 10% of the cases. No written records were kept in 63.0 % of the encounters. CONCLUSIONS: The problems and difficulties present in delivering primary care in Turkey include the physicians' behavior in addition to working conditions.

Comparison of clinical skills of 3rd-year students who completed structured clinical skills program with 6th-year students who acquired clinical skills in unsystematic way.

BACKGROUND: The timing and methods of teaching clinical skills are some of the main concerns of medical education. PURPOSE: The aim of this study was to compare clinical skills of the 3rd and 6th-year students who acquired clinical skills training within different years and methods. METHODS: Randomly chosen students were observed and evaluated in the form of "did it-didn't do it" over the checklists composed of parameters of communication, history taking, and physical examination. The results were evaluated on the SPSS 10.0 for Windows program and Pearson chi-square test was used in the statistical analyses. RESULTS: Third-year students who had clinical skills training in early years and structured methods had better results for most of the parameters (p < .05). CONCLUSIONS: The clinical skills training given through a structured program that is widespread in the early years of medical school makes a great contribution to the development of students' clinical skills.