April 13, 2009 at 11:56 am | Essay Submissions | 
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- Paul Di Capua (paul.dicapua) [Forum Discussion]
Introduction
In a cohort of 80 undiagnosed patients presenting to a primary care center, the medical interview alone yielded the correct diagnosis in 76% of visits.1 Another study found that while diagnostic imaging was accurate in only 35% of cases, the combination of the medical history and physical examination produced the right diagnosis in 70% of cases.2 Physicians facing malpractice claims are less likely to use patient‐centered interviewing than are physicians without malpractice claims.3 Moreover, patients are significantly less satisfied with their visits when physicians ignore psychosocial aspects of their care.4 As Holmboe argues, clinical skills, defined as the medical interview, physical examination and counseling, “remain the most important and effective diagnostic and therapeutic tools.” 5 The most important change required of health care education is ensuring all providers are equipped with high quality clinical skills; this can be achieved by the implementation of a quality improvement mechanism in health care education.
Quality improvement is the fundamental driver of this proposal. Lessons from industrial manufacturing on quality teach us the value of observation and feedback in continually improving quality. However, the current system of health care education lacks structure and yields graduates with low quality clinical skills. This essay proposes the implementation of a system of observation and feedback as means of assessing and improving providers’ clinical skills. For medical education, this can be achieved through the implementation of the mini‐CEX, a validated evaluation tool discussed in greater detail below. I support my argument by describing my own experience of implementing the mini‐CEX at a student‐run clinic at my medical school. A significant shift towards quality improvement in education may result in a cultural change in medicine in which providers continually help each other improve their care of patients.