Faculty, grads differ on what's "must-know"

New doctors and faculty physicians don't agree on the clinical procedures essential to learn in medical school, a study shows.

Fifty-one teaching physicians at Wake Forest University School of Medicine were asked to rate 31 basic clinical procedures -- from a throat culture to a spinal tap -- based on importance in the first year after medical school graduation. They rated 14 procedures as ones every doctor "must know."

But just six of those procedures were viewed as essential by 184 new physicians, who were graduates of the medical school or residents at Wake Forest University Baptist Medical Center. These doctors placed five other procedures into the "must-know" category, including lumbar puncture and arterial line placement. The findings were published in the April issue of Medical Teacher, an international journal published by the Assn. for Medical Education in Europe.

"One of the good things about the outcome of this study is that we are starting to identify those core procedures that every student should learn in medical school," according to a statement by study lead author Michael T. Fitch, MD, PhD, an assistant professor of emergency medicine at Wake Forest's medical school.

Wake Forest faculty already had decided that teaching changes were needed. The changes were prompted by the realization that some students were about to graduate having never performed some of the basics, such as putting in an IV.

The survey revealed that young physicians rated more invasive procedures, such as the draining of abscesses and intubation, as being more essential than minimally invasive procedures, such as throat culture and phlebotomy. Minimally invasive procedures were thought to be essential by teaching physicians.

Researchers said new physicians might not have thought basic procedures were essential since many were performed by other health professionals, including nurses.

M. Brownell Anderson, senior director of educational programs at the Assn. of American Medical Colleges, said one limitation of the study is that most of the students were from the Wake Forest program. "If a national survey was done, we might be able to draw broad conclusions," she said.