Improving residents' clinical skills with the structured clinical instruction module for breast cancer: Results of a multiinstitutional study

Background. The purpose of this study was to determine, in a multiinstitutional setting, the effectiveness of the structured clinical instruction module (SCIM) as an instructional format for surgical residents. Methods. The breast cancer SCIM is an abbreviated (3-hour) clinical skills course that places residents in realistic clinical settings. The curriculum encompasses all aspects of breast cancer patient assessment. The SCIM was administered to 137 residents at five institutions. Sixty-six faculty members and 52 patients participated. All participants were surveyed with multiitem questionnaires. The residents were also asked to perform a self-assessment of their shills before and after the SCIM. Results. The SCIM was delivered at all institutions without difficulty. All participants rated the SCIM highly (from 'above average' to 'outstanding'). Mean ratings (on a 5-point scale)for the overall effectiveness of the SCIM as an educational format follow: Institution A B C D E Patients 4. 75 4. 73 4.56 4.56 4.44 Faculty members 4.47 4.57 4.82 4.76 4.25 Residents 4.38 4.75 4.29 4.36 4.68. The pretest mean (on a 5-point scale) on the self-assessment was 2.46 ('less than competent'); the posttest mean was 3.54 ('more than competent') (p < 0.0001). Conclusions. Residents are acutely aware of their deficiencies in understanding breast cancer. The SCIM is a standardized, reproducible, portable, and effective educational vehicle.