Evaluation of physical examination skills. Reliability of faculty observers and patient instructors.

Effective teaching of physical examination skills requires an evaluation system that can identify trainees who need further instruction. To study the evaluation of physical examination skills by faculty observers and patient instructors, the reliability of their observation of medical students performing a general physical examination was measured. Faculty observers did not reliably evaluate 32% of examination skills. Faculty agreement was lowest when observing components of the head, neck, and abdominal examinations. Patient instructors, with limited faculty training, reliably evaluated 83% of those skills that were reliably assessed by the faculty. These findings demonstrate limitations in the current methods of evaluating performance and point out the need to examine systems of trainee assessment.