Assessment of the otoscopic skills of general practitioners and medical students: is there room for improvement?

Ear, nose and throat problems are common in general practice, yet undergraduate and postgraduate teaching in the subject is variable and often sparse. The assumption that direct experience in otoscopy in practice will compensate for inadequate previous tuition was tested by assessing a group of 53 general practitioners and 59 medical students. Confidence in otoscopy was assessed using a visual analogue scale and skill was assessed by clinical examination of four ears. Otoscopy was divided into identifying the tympanic membrane, distinguishing a normal from an abnormal membrane and identifying specific features of the membrane. The medical students and general practitioners were comparable in both confidence and skill for all parameters except skill in identification of specific features of the tympanic membrane, in which the students' ability was greater (Student's t-test, P < 0.01). In both groups the percentage of false negative observations was reassuringly low--for students the mean was 3.0%; and for general practitioners 4.3%. There is room for improvement in general practitioner's training in otoscopy. Supervised tuition is essential and cannot be compensated for by unsupervised experience. More involvement with ear, nose and throat problems in vocational training or attendance at continuing education courses is suggested.