Original Article

:Assessment of training needs of fresh medical graduates in Clinical Breast Examination-Cross-sectional study from India

Anita Khokhar and ZH Khan
World Journal of Epidemiology and Cancer Prevention 2017, 6:1

Abstract

Background

In order to be able to detect it at the earliest t is essential that the physicians are able to perform a good clinical breast exam. Also Clinical Breast Examination (CBE) presents the physician with an opportunity to make the women aware about their breasts. But whether our medical graduates are trained well enough to a good breast exam needs to be assessed.

Material and Methods

The present study was conducted in New Delhi, capital of India. Since there is paucity of literature on this topic in India the sample size was calculated with p to be 50% so as to get the maximum sample size. Allowable error was fixed at 5%. Calculated sample size was 400. Study subjects were fresh medical graduates who had completed one year of compulsory internship posting. Data was collected from students who had reported for interviews for junior residency at various hospitals both teaching as well as non-teaching located in Delhi in the year 2014. A self-administered questionnaire was prepared in English. Questionnaire was given to them to be filled after the interview was over as then subjects could be freely contacted. Data was entered in Excel sheet. Analysis was done using SPSS licensed version 21.0.Simple and cross tables were made. Also appropriate tests of significance were applied. P value of <0.05 was taken to be significant.

Results

Mean age of the participants was 23.8 years. 278(67.8%) of the participants were females and 132 (32.2%) were males. 271 (66.1%) of the participants were from a government medical college and 129 (31.5%) from private medical college. Out of a total of 410 participants 402 (98%) mentioned that they knew how to perform a CBE whereas 08 (1.95%) said they did not know how to do it. On being enquired about indications of doing a clinical breast exam majority mentioned 269 (66.9%) if a woman with a breast problem approached them then, 12 (3%) said for all women more than 40 years of age as a screening method and 121 (30.1%) mentioned in both the situations. A low proportion, 84 (20.9%) actually knew the correct perimeter of the breast. Participants also did not have adequate knowledge about the part of the hand to be used for palpation as only 116 (28.85%) responded that pads of middle three fingers should be used. Vertical strip pattern which is said to cover maximum breast area was stated by only 18 (4.5%). 99.5% (400) knew that nipples were to be examined as a part of CBE but did not know that spontaneous discharge from breast is an important sign of breast cancer. 87 (21.6%) even stated that they had never done a clinical breast exam. Only 2 (0.50%) had done more than 5 breast exams during graduation. A large number of 390 (97.0%) stated that they were not confident of doing a CBE and the main reason cited for that was not enough clinical exposure and practice. Out of 392 who stated they further wanted training main reasons cited were that as a part of general; practice this skill is required 248 (61.7%), cancer is on the increase and hence one must learn CBE, 191 (47.5%), half of the women are patients 54 (13.4%). 301/392 (74.9%) said they would like to teach the women about breast self-awareness while doing a CBE whereas 91/392 (22.6%) were apprehensive that either the lady might not understand or they might not have enough time to explain the procedure to the lady who comes to them. On being enquired about how would they like to improve their CBE skill responses were by practicing on patients 214/392 (54.6%), 174/392 (44.4%), by practicing on models/mannequin and 98(25%) by seeing videos.

Conclusion

A structured training programme for imparting skill of CBE should be formulated for the medical graduates so that they can contribute towards breast cancer screening of the large number of needy women.

Key words

Clinical breast examination, training needs assessment, India, medical graduates

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