Evaluation of conventional training in Clinical Breast Examination (CBE).
Daisy Veitch, Richard Goossens, Harry Owen and 3 others
PMID 31104050WHAT IT FOUND
Ten novice medical students were wrong in 66% of breast examinations after training.
They missed 6 of 10 true cancers and falsely referred 27 normal breasts. Existing tests checked hand technique and confidence, not ability to detect lumps.
Key findings
01Students were incorrect in 66% of their clinical examinations, missing 6 of 10 true positives and falsely identifying 27 of 40 normal breasts as having a lump.
02There was no significant relationship between a student's actual ability to detect lumps and their self-reported confidence, proctor marks, or patient ratings.
03All students passed the conventional assessment based on physical manoeuvres, even the student who missed the cancer and referred all four normal breasts.
STILL TO COME
How it was doneWhat they found
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What it does not show
The study included only 10 students and 50 examinations, making the results highly susceptible to individual variation. Only one real patient with a palpable cancer was examined, so the ability to detect other types or sizes of masses was not tested. The training lasted only 30 minutes, which may not reflect standard medical school curricula. The Competence Score was calculated using an arbitrary weighting method described by the authors as being for simplicity. The proctor scores showed a narrow range, suggesting a central tendency bias where it is difficult to fail a student on technique alone.
Declared interests
The research was self-funded by the authors, and they reported no conflicts of interest.
The easy way to misread this
Do not conclude that all medical students or clinicians are unable to perform breast examinations. These results apply to novice students after a single 30-minute training session in a study of only ten people. It shows that current assessment methods for beginners do not verify lump detection ability, not that experienced clinicians miss cancers.