Evaluation of procedural skills of internal medicine residents.

In 1983 the American Board of Internal Medicine mandated that training programs assess residents in procedural skills prior to board certification. Beginning in 1984, the University of Hawaii developed an assessment and testing program that consists of a three-phase evaluation process for qualifying internal medicine residents in basic procedural skills: an observation period spanning the three-year residency, a 100-question multiple-choice examination, and a slide-identification examination involving simple identification of body fluid elements. From 1984 through 1987 the mean scores of both examinations were analyzed for each level of residency and for each year of testing to assess whether curriculum changes were effective. There was a statistically significant improvement (p less than .005) in performance on both the multiple-choice and the slide-identification examinations as the residents progressed through the program. No difference in performance was found for the multiple-choice examination between calendar years, but a significant difference (p less than .01) was found for the slide-identification examination between calendar years. Despite perceptions by the faculty that their increased emphasis on the learning of procedural skills has been successful, the multiple-choice examination results over time do not support this belief. These findings suggest that residents need more structured curriculum guidelines to aid their learning and faculty members require better direction in the educational goals for procedural skills training.