A majority of fourth-year medical students still have never performed important procedures, and a substantial minority have not performed basic procedures.

A 3-hour instructional workshop is a feasible and effective method to help residents improve their teaching skills, their confidence in teaching, and the approaches they use to teach medical students on the wards.

Purpose To determine how examination findings influence the probability assessment and diagnostic decision-making of third- and fourth-year medical students, internal medicine residents, and academic general internists. Method In a 2008 cross-sectional, Web-based survey, participants from three medical schools were asked questions about their training and eight examination scenarios representing four conditions. Participants were given literature-derived pre-examination probabilities (pre-EPs) for each condition and were asked to 1) estimate post-examination probabilities (post-EPs) and 2) select a diagnostic choice (either report that condition is present, order more tests to establish diagnosis, or report that condition is absent). Participants’ inverse transformed logit (ITL) mean post-EPs were compared with corresponding literature-derived post-EPs. Results Of 906 individuals invited to participate, 684 (75%) submitted a completed survey. In two of four scenarios with positive findings, the participants’ ITL mean post-EPs were significantly less than corresponding literature-derived post-EP point estimates (P <.001 for each). In three of the four scenarios consisting of negative findings, ITL mean post-EPs were significantly greater than corresponding literature-derived post-EP point estimates (P <.001 for each). In the four scenarios with positive findings, 17%–38% of participants ordered more diagnostic tests when the literature indicated a >85% probability that the condition was present. In the four scenarios with largely negative findings, 70%–85% chose to order diagnostic tests to further reduce diagnostic uncertainty. Conclusions All three groups tended to similarly underestimate the impact of examination findings on condition probability assessment, especially negative findings, and often ordered more tests when probabilities indicated that additional testing was unnecessary.