Canadian radiology workforce demographics: Results from a national survey.

Rationale and objective: Demographic data collected about Canadian radiologists and trainees has been limited primarily to binary gender and geographic location. The purpose of this study was to investigate: (1) demographic characteristics of Canadian radiologists and trainees; (2) types of diversity important to radiologists; (3) relationship of radiologist demographics to practice characteristics; and (4) relationship of radiologist demographics to years in practice, (YIP). Materials and methods: French and English surveys were distributed via email through radiology associations and social media. Frequency counts of demographic variables were calculated, and chi-square and Fisher's Exact tests were performed to explore the relationships between demographic characteristics and role. Results: 611 individuals responded to the survey. 573 respondents were included in the analysis. 454 (78.8%) were practicing radiologists and 119 (20.7%) were residents/fellows. Half identified as women (50.4%). English was the primary language for most respondents. There was an association between role and sexual orientation (p = 0.02), visible minority (χ2 = 4.79, p < 0.05), religion (χ2 = 4.11, p < 0.05), and having children (χ2 = 136.65, p < 0.05). For radiologists, being a visible minority (χ2 = 11.59, p < 0.05) and age (χ2 = 56.3, p < 0.05) were associated with academic rank while gender (χ2 = 3.83, p < 0.05) and age (χ2 = 13.74, p < 0.05) were related to part-/full-time status. Less women, visible minorities, and women with children had been in practice for long. Discussion: This study represents a comprehensive analysis of Canadian radiology demographics. Results suggest there is increasing diversity among trainees; however, significant demographic underrepresentation compared to the diversity of Canada exists.

Canadian Radiology Gender Pay Gap-Reality or Myth?

Introduction: Prior studies on Canadian physicians' income have demonstrated a gender pay gap (GPG); however, there is a paucity of data in the Radiology specialty. A cross-sectional study was conducted to determine if practicing Canadian radiologists' self-reported income is related to gender, controlling for demographic and work variables. Methods: English and French online surveys were distributed by email and social media to radiologists and trainees (May-July 2021). The association between Gender (controlling for Ethnicity variables, Region, having Children, Full-/Part-Time work, and Academic position) and Self-Reported Income was examined using chi-square tests. Pearson correlations examined relationships between opinion variables. Analyses were conducted using SPSS V28.0. A priori significance was P < .05. Study had ethics approval. Results: Four hundred and fifty-four practicing Canadian radiologists responded. Majority were women (51.2%, n = 227), a non-visible Minority (71.7%, n = 317), and from Western Provinces (67.8%, n = 308). Significant relationship was established between Self-Reported Income and Gender (χ2 = 10.44, df = 2, P < .05). More men (70.6%, n = 120) than women (56.4%, n = 110), reported income "greater than $500 000"; fewer men (20.6%, n = 35) than women (35.9%, n = 70) reported "$300 000-$500 000"; a similar percent of men (8.8%, n = 15) and women (7.7%, n = 15) reported "less than $300 000." No relationship was found between self-reported income and gender for ethnicity variables, those without children, part-time, or non-academic radiologists. The opinion "Addressing the GPG is important" correlated to "Canadian Association of Radiologists should collect demographic data" (r = 0.63). Responses were low for ethnic minorities and non-western provinces. Conclusion: Our results suggest a GPG exists in Canadian radiology and is an important first step for future studies.

Difficulties with Learning Musculoskeletal Physical Examination Skills: Student Perspectives and General Lessons Learned for Curricular Design.

Phenomenon: The development of foundational clinical skills, such as physical examination, is essential to becoming a competent clinician. Musculoskeletal medicine is often considered a specialized area of practice despite the high prevalence of musculoskeletal conditions in the general population and presenting to general clinical practices. Prior work has shown that medical learners and practicing clinicians have low confidence in these skills but understanding of the student perspective on why these skills are more difficult to acquire is unclear.Approach: Our study was guided by social constructivist learning theory to explore the learner experience and present their perspectives. Qualitative analysis investigated the difference between learning musculoskeletal physical examination versus other body systems, using the voices from 11 semi-structured focus group interviews. Participants included third-year medical students across two academic cohorts at one institution. Our analysis was grounded in the principles of phenomenology and used triangulation and reflexivity to provide rigorous analysis.Findings: Students provided rich and insightful perspectives regarding their experiences in learning musculoskeletal physical examination techniques. Four themes were developed from our data: a) the need for opportunities for both supervised and self-directed practice; b) assessment and competence as motivations for learning; c) the need for a different approach to the content and structure of musculoskeletal medicine and its associated examination techniques; and d) the need for distinct expertise and technical skill from musculoskeletal examination teachers.Insights: This study provides a valuable lens to critically reflect on existing curriculum and pedagogical approaches to musculoskeletal examination skills. Lessons from this study may be applicable to curriculum design in general, especially the teaching of physical examination skills, such as how it is taught and integrated with other content (including anatomy), how much practice is required, who teaches physical examination skills, and what faculty development is needed to standardize teaching. Promoting a learner-centered approach to the teaching and learning of these clinical skills will be beneficial to all stakeholders, especially to our future physicians and their patients.Supplemental data for this article is available online at https://doi.org/10.1080/10401334.2021.1954930 .

Development of professionalism vignettes for the continuum of learners within a medical and nursing community of practice.

BACKGROUND: It is challenging to develop professionalism curricula for all members of a medical community of practice. We collected and developed professionalism vignettes for an interactive professionalism curriculum around our institutional professionalism norms following social constructivist learning theory principles. METHODS: Medical students, residents, physicians, nurses and research team members provided real-life professionalism vignettes. We collected stories about professionalism framed within the categories of our Faculty's code of conduct: honesty; confidentiality; respect; responsibility; and excellence. Altruism was from the Nursing Code of Ethics. Two expert committees anonymously rated and then discussed vignettes on their educational value and degree of unprofessional behaviour. Through consensus, the research team finalized vignette selection. RESULTS: Eighty cases were submitted: 22 from another study; 20 from learners and nurses; and 30 from physicians; and eight from research team members. Two expert committees reviewed 53 and 42 vignettes, respectively. The final 18 were selected based upon: educational value; diversity in professionalism ratings; and representation of the professionalism categories. CONCLUSION: Realistic and relevant professionalism vignettes can be systematically gathered from a community of practice and their representation of an institutional norm, educational value, and level of professional behaviour can be judged by experts with a high level of consensus.

CONTEXTE: Il est difficile de concevoir des programmes d'enseignement sur le professionnalisme pour l'ensemble des membres d'une communauté de pratique médicale. Nous avons recueilli et préparé des scénarios pour un programme interactif sur le professionnalisme, fondé sur les normes de notre établissement en la matière, selon une approche socioconstructiviste de l'apprentissage. MÉTHODES: Des étudiants en médecine, des résidents, des médecins, des infirmières et des membres de l'équipe de recherche ont proposé des scénarios de situations de la vie réelle sur le sujet du professionnalisme. Nous avons recueilli des témoignages sur le professionnalisme s'inscrivant dans les catégories du code de conduite de notre faculté, à savoir l'honnêteté, la confidentialité, le respect, la responsabilité et l'excellence, auxquelles s'ajoute l'altruisme, tiré du Code de déontologie des soins infirmiers. Deux comités d'experts ont examiné la valeur éducative et le degré de non-professionnalisme décrit, et ils ont évalué de façon anonyme les scénarios. L'équipe de recherche a fait la sélection finale de scénarios par consensus. RÉSULTATS: Parmi les 80 cas soumis, 22 provenaient d'une autre étude, 20 ont été proposés par des apprenants et des infirmières, 30 par des médecins et huit par des membres de l'équipe de recherche. Deux comités d'experts ont examiné 53 et 42 scénarios, respectivement. Les 18 scénarios retenus ont été choisis pour leur valeur éducative, la diversité des évaluations du professionnalisme et leur représentativité des diverses catégories de professionnalisme. CONCLUSION: Des scénarios réalistes et pertinents sur le sujet du professionnalisme peuvent être systématiquement recueillis auprès de communautés de pratique. Des experts peuvent déterminer, avec un degré élevé de consensus, la valeur éducative des scénarios, le niveau du comportement professionnel qu'ils décrivent et dans quelle mesure ils reflètent les normes de l'établissement concerné.

Deconstructing the Joint Examination: A Novel Approach to Teaching Introductory Musculoskeletal Physical Examination Skills for Medical Students.

Introduction: Musculoskeletal (MSK) disorders are very common, but suboptimal teaching of MSK medicine occurs and expert clinicians agree that MSK physical examination (PE) skills can be confusing and complicated for medical students. An innovative approach in introductory teaching of MSK PE skills was developed using constructivist theory for second-year medical students. Methods: We implemented the MSK PE curriculum innovation in the second year of a four-year MD program, utilizing a standard framework with spaced practice and clinician coaching. We evaluated this curriculum by comparing the innovation group (n = 123) to a historical control group (n = 134) using an anonymous survey and OSCE station scores. Data analysis included repeated measures analysis of variance comparing students' self-confidence in MSK PE to students' self-confidence in other systems-based PEs, as well as independent t-test comparisons of self-confidence scores and MSK-specific OSCE station scores between the historical and innovation groups. Results: The mean self-assessed confidence of the historical group was significantly lower for the MSK PE than all other PEs (p < 0.001), except for the neurological PE. Significant improvement in MSK PE self-confidence was noted with the innovation group (t(259) = -4.05, p < 0.001). OSCE scores significantly improved in MSK-specific stations, with medium to large effect size across the different stations. Discussion: We successfully used a framework of deconstruction, repetition, and spaced practice to develop fundamental MSK PE skills in preclerkship medical students. This curriculum structure provides an effective example for teaching introductory MSK PE skills to early medical learners.

Ten tips for conducting focused ethnography in medical education research.

Background: Medical education researchers increasingly use qualitative methods, such as ethnography to understand shared practices and beliefs in groups. Focused ethnography (FE) is gaining popularity as a method that examines sub-cultures and familiar settings in a short time. However, the literature on how FE is conducted in medical education is limited. Aim: This paper provides 10 practical tips for conducting FE in medical education research. Methods: The tips were developed based on our expertise in ethnographic research and existing literature. Results: The 10 tips include: (1) Know the difference, (2) Build relationships before you start, (3) Have shared purpose and knowledge translation strategies with your stakeholders (4) Practice being reflexive, (5) Align research question with methodology, (6) Prepare your fieldwork, (7) Use a variety of methods for data collection, (8) Consider context on micro, meso, and macro levels, (9) Use triangulation, and (10) Provide a 'thick description', Conclusions: These 10 tips give practical guidance to medical educators in thinking about how and when to conduct FE.

Assessment of Resident Physicians' Communicator and Collaborator Competencies by Interprofessional Clinicians: A Mixed-Methods Study.

Phenomenon: As we move toward competency-based medical education, greater emphasis is being placed on assessing a more comprehensive skill set, including the ability to communicate and collaborate effectively in the workplace. Nonphysician members on interprofessional (IP) teams have valuable perspectives on actual resident performance and are often not adequately engaged in the provision of feedback to residents. Based on the educational theories of collaborative evaluation and social constructivism, this research examined the ability of IP clinicians to provide feedback to residents. The aim of this study was to examine IP clinicians' perceptions of their ability to provide formative feedback, through their observations and assessments of developmental pediatric residents, compared to physician supervisors on the rotation, and to qualitatively explore potential barriers to the feedback process from their perspective. APPROACH: This explanatory, sequential mixed-methods design study first examined which and how many of the CanMEDS Communicator and Collaborator training objectives (N = 40) were considered to be observable and assessable by IP clinicians and physicians. A comparison of the mean number of objectives that were observed and practically assessed by (a) each group (IP clinicians vs. physicians) and (b) clinical service teams during the core developmental pediatrics rotations, were examined using independent t tests. Second, a thematic qualitative analysis of focus groups was used to develop a contextual understanding of the factors that influenced this process. Data were analyzed using three levels of open coding and descriptive qualitative analysis techniques. FINDINGS: Physicians reported they could observe (M = 33.3, SD = 5.2, 83.3%) and assess (M = 31.5, SD = 7.3, 79%) a larger number of objectives compared to the IP clinician group (M = 24.7, SD = 8.6, 61.8% and M = 20.3, SD = 10.6, 51%, respectively). There were no differences between the clinical service teams (i.e., preschool/school-age and pediatric rehabilitation). The objective that was most observable and assessable by the IP clinicians was "Demonstrates a respectful attitude towards other colleagues and members of an interprofessional team." Four themes identified by the IP clinicians provided more in-depth qualitative information: (a) assessment requires more than simple observation, (b) assumptions and indirect observation influence assessment, (c) clinic culture and structure shapes observation and assessment, and (d) specific assessment criteria are required by IP clinicians. Insights: IP clinicians have the desire and ability to provide formative feedback to residents. Formalized processes with specific evaluation criteria would facilitate meaningful feedback from IP clinicians in the assessment of residents as they journey toward competence.

Perceptions of Unprofessional Social Media Behavior Among Emergency Medicine Physicians.

BACKGROUND: Use of social media (SM) by physicians has exposed issues of privacy and professionalism. While guidelines have been created for SM use, details regarding specific SM behaviors that could lead to disciplinary action presently do not exist. OBJECTIVE: To compare State Medical Board (SMB) directors' perceptions of investigation for specific SM behaviors with those of emergency medicine (EM) physicians. METHODS: A multicenter anonymous survey was administered to physicians at 3 academic EM residency programs. Surveys consisted of case vignettes, asking, "If the SMB were informed of the content, how likely would they be to initiate an investigation, possibly leading to disciplinary action?" (1, very unlikely, to 4, very likely). Results were compared to published probabilities using exact binomial testing. RESULTS: Of 205 eligible physicians, 119 (58%) completed the survey. Compared to SMB directors, EM physicians indicated similar probabilities of investigation for themes involving identifying patient images, inappropriate communication, and discriminatory speech. Participants indicated lower probabilities of investigation for themes including derogatory speech (32%, 95% confidence interval [CI] 24-41 versus 46%, P < .05); alcohol intoxication (41%, 95% CI 32-51 versus 73%, P < .05); and holding alcohol without intoxication (7%, 95% CI 3-13 versus 40%, P < .05). There were no significant associations with position, hospital site, years since medical school, or prior SM professionalism training. CONCLUSIONS: Physicians reported a lower likelihood of investigation for themes that intersect with social identity, compared to SMB directors, particularly for images of alcohol and derogatory speech.

Clinical teaching as part of continuing professional development: Does teaching enhance clinical performance?

INTRODUCTION: Physicians identify teaching as a factor that enhances performance, although existing data to support this relationship is limited. PURPOSE: To determine whether there were differences in clinical performance scores as assessed through multisource feedback (MSF) data based on clinical teaching. METHODS: MSF data for 1831 family physicians, 1510 medical specialists, and 542 surgeons were collected from physicians' medical colleagues, co-workers (e.g., nurses and pharmacists), and patients and examined in relation to information about physician teaching activities including percentage of time spent teaching during patient care and academic appointment. Multivariate analysis of variance, partial eta squared effect sizes, and Tukey's HSD post hoc comparisons were used to determine between group differences in total MSF mean and subscale mean performance scores by teaching and academic appointment data. RESULTS: Higher clinical performance scores were associated with holding any academic appointment and generally with any time teaching versus no teaching during patient care. This was most evident for data from medical colleagues, where these differences existed across all specialty groups. CONCLUSION: More involvement in teaching was associated with higher clinical performance ratings from medical colleagues and co-workers. These results may support promoting teaching as a method to enhance and maintain high-quality clinical performance.

The relationship between measures of unprofessional behavior during medical school and indices on the California Psychological Inventory.

BACKGROUND: Research studies on physicians disciplined by state medical boards showed specific types of unprofessional behavior were predictive of later disciplinary action. Similarly, law enforcement officers who received disciplinary action scored lower on certain scales of the California Psychological Inventory (CPI). METHOD: This study used a case-control descriptive design and independent t tests to examine differences in scores on six psychological indices (CPI scales) by level of unprofessional behavior during medical school. RESULTS: Physicians who demonstrated unprofessional behavior during medical school versus those who did not scored significantly lower on four CPI scales. Results are consistent with findings in which general unprofessional behavior during medical school can be further characterized to domains of irresponsibility, lack of self-improvement, and poor initiative. CONCLUSIONS: The psychological indices of the CPI scales differed by level of unprofessional behavior, which leads one to wonder whether the use of personality measures should be considered during the admissions process to medical school.

Differences in cancer prevention knowledge and experience among medical students at three institutions over time.

BACKGROUND: To evaluate the effect of an enhanced cancer prevention curriculum on medical students' changes in knowledge, self-perceived competence, and educational experience in cancer prevention during the first three years of medical school at three different institutions. METHODS: MANOVAs were used to compare the differences in mean knowledge scores and self-reported competence in counseling and performing screening exams among the institutions at pre-test and post-test, respectively. We also calculated a change score for the two institutions that used the same ID codes to track students and used a MANCOVA for comparison in order to adjust for pretest scores. Pearson chi-square tests were used to compare educational experience. RESULTS: The three schools significantly (p < .01) differed from each other in mean knowledge scores and self-perceived competence at both survey times. For all three institutions, post-test scores were significantly higher than pre-test scores (p < .001). The students of the three schools also reported significantly (p < .05) different amounts of educational experience in most areas. CONCLUSIONS: The varied amount of direct instruction in cancer prevention received by the students at the three institutions may account for the variation in outcomes. Findings demonstrate the effect of the enhanced curriculum.

Disciplinary action by medical boards and prior behavior in medical school.

BACKGROUND: Evidence supporting professionalism as a critical measure of competence in medical education is limited. In this case-control study, we investigated the association of disciplinary action against practicing physicians with prior unprofessional behavior in medical school. We also examined the specific types of behavior that are most predictive of disciplinary action against practicing physicians with unprofessional behavior in medical school. METHODS: The study included 235 graduates of three medical schools who were disciplined by one of 40 state medical boards between 1990 and 2003 (case physicians). The 469 control physicians were matched with the case physicians according to medical school and graduation year. Predictor variables from medical school included the presence or absence of narratives describing unprofessional behavior, grades, standardized-test scores, and demographic characteristics. Narratives were assigned an overall rating for unprofessional behavior. Those that met the threshold for unprofessional behavior were further classified among eight types of behavior and assigned a severity rating (moderate to severe). RESULTS: Disciplinary action by a medical board was strongly associated with prior unprofessional behavior in medical school (odds ratio, 3.0; 95 percent confidence interval, 1.9 to 4.8), for a population attributable risk of disciplinary action of 26 percent. The types of unprofessional behavior most strongly linked with disciplinary action were severe irresponsibility (odds ratio, 8.5; 95 percent confidence interval, 1.8 to 40.1) and severely diminished capacity for self-improvement (odds ratio, 3.1; 95 percent confidence interval, 1.2 to 8.2). Disciplinary action by a medical board was also associated with low scores on the Medical College Admission Test and poor grades in the first two years of medical school (1 percent and 7 percent population attributable risk, respectively), but the association with these variables was less strong than that with unprofessional behavior. CONCLUSIONS: In this case-control study, disciplinary action among practicing physicians by medical boards was strongly associated with unprofessional behavior in medical school. Students with the strongest association were those who were described as irresponsible or as having diminished ability to improve their behavior. Professionalism should have a central role in medical academics and throughout one's medical career.

Domains of unprofessional behavior during medical school associated with future disciplinary action by a state medical board.

BACKGROUND: In a previous study, we showed that unprofessional behavior in medical school was associated with subsequent disciplinary action. This study expands on that work by identifying the domains of unprofessional behavior that are most problematic. METHOD: In this retrospective case-control study, negative comments were extracted from student files for 68 case (disciplined) and 196 matched control (nondisciplined) physicians. Comments were analyzed qualitatively and subsequently quantified. The relationship between domains of behavior and disciplinary action was established through chi-square tests and multivariate analysis of variance. RESULTS: Three domains of unprofessional behavior emerged that were related significantly to later disciplinary outcome: (1) poor reliability and responsibility, (2) lack of self-improvement and adaptability, and (3) poor initiative and motivation. CONCLUSIONS: Three critical domains of professionalism associated with future disciplinary action have been defined. These findings could lead to focused remediation strategies and policy decisions.

A national study of medical student clinical skills assessment.

BACKGROUND: This study describes comprehensive standardized patient examinations in medical schools nationally. METHOD: We surveyed 121 medical school curriculum deans regarding their use of standardized patient assessments. Questions addressed examination characteristics, funding sources, and collaborations. RESULTS: A total of 91 of 121 curriculum deans responded (75% response rate). The majority (84%) of respondents report conducting a comprehensive clinical skills assessment during the third or fourth year of medical school. Most programs are funded with dean's office monies. Although many collaborate with other institutions for examination development, the majority of schools score and remediate students independently. Two-thirds of all respondents (61/91) report that the new standardized patient licensing requirement elevates the importance of in-house clinical skills examinations. CONCLUSIONS: Most medical schools now conduct comprehensive clinical skills assessments after the core clerkships, and collaboration is common. These results suggest increasing emphasis on clinical and communication skills competency and opportunities for collaborative research.

Promoting research in medical education at the University of California, San Francisco, School of Medicine.

Over the past seven years, educational innovations and scholarship have flourished at the University of California, San Francisco, (UCSF) School of Medicine. Prior to 1998, there was no infrastructure to support educational research and yet a few faculty members published in medical education journals and were active in national professional associations. With the initiation of curriculum reform in 1998, a great deal of excitement about education was generated and innovative new educational programs were envisioned. These changes became opportunities for educational scholarship. With the development of an Office of Medical Education in 1997 and the Haile T. Debas Academy of Medical Educators in 2001, the infrastructure was in place to expand educational research and the scholarship of teaching. The components of this support include educational leadership, faculty development, the Teaching Scholars Program, the Office of Educational Research and Development, the Academy, a Fellowship in Medical Education Research, collaborative research, and extramural grants. As a result of these investments, the number of UCSF faculty members who are involved in educational research has increased significantly. There has been a four-fold increase in peer-reviewed articles published in medical education journals and a greater increase in the publication of educational abstracts, editorials, chapters, and books, plus presentations at U.S. professional association meetings. In this article, the authors describe the changes that have occurred at UCSF to achieve these results.

Communication skills in standardized-patient assessment of final-year medical students: a psychometric study.

The purpose of this study is to investigate the content-specificity of communication skills. It investigates the reliability and dimensionality of standardized patient (SP) ratings of communication skills in an Objective Structured Clinical Examination (OSCE) for final year medical students. An OSCE consisting of seven standardized patient (SP) encounters was administered to final-year medical students at four medical schools that are members of the California Consortium for the Assessment of Clinical Competence (N = 567). For each case, SPs rated students' communication skills on the same seven items. Internal consistency coefficients were calculated and a two-facet generalizability study was performed to investigate the reliability of the scores. An exploratory factor analysis was conducted to examine the dimensionality of the exam. Findings indicate that communication skills across the seven-case examination demonstrate a reliable generic component that supports relative decision making, but that a significant case-by-student interaction exists. The underlying structure further supports the case-specific nature of students' ability to communicate with patients. From these findings, it is evident that individual's communication skills vary systematically with specific cases. Implications include the need to consider the range of communication skill demands made across the OSCE to support generalization of findings, the need for instruction to provide feedback on communication skills in multiple contexts, and the need for research to further examine the student, patient, and presenting problem as sources of variation in communication skills.

Unprofessional behavior in medical school is associated with subsequent disciplinary action by a state medical board.

PURPOSE: To determine if medical students who demonstrate unprofessional behavior in medical school are more likely to have subsequent state board disciplinary action. METHOD: A case-control study was conducted of all University of California, San Francisco, School of Medicine graduates disciplined by the Medical Board of California from 1990-2000 (68). Control graduates (196) were matched by medical school graduation year and specialty choice. Predictor variables were male gender, undergraduate grade point average, Medical College Admission Test scores, medical school grades, National Board of Medical Examiner Part 1 scores, and negative excerpts describing unprofessional behavior from course evaluation forms, dean's letter of recommendation for residencies, and administrative correspondence. Negative excerpts were scored for severity (Good/Trace versus Concern/Problem/Extreme). The outcome variable was state board disciplinary action. RESULTS: The alumni graduated between 1943 and 1989. Ninety-five percent of the disciplinary actions were for deficiencies in professionalism. The prevalence of Concern/Problem/Extreme excerpts in the cases was 38% and 19% in controls. Logistic regression analysis showed that disciplined physicians were more likely to have Concern/Problem/Extreme excerpts in their medical school file (odds ratio, 2.15; 95% confidence interval, 1.15-4.02; p =.02). The remaining variables were not associated with disciplinary action. CONCLUSION: Problematic behavior in medical school is associated with subsequent disciplinary action by a state medical board. Professionalism is an essential competency that must be demonstrated for a student to graduate from medical school.

Predictors of self-perceived competency in cancer screening examinations.

BACKGROUND: Factors contributing to medical students' self-perceived competency in cancer screening examinations have not been well studied. METHODS: Ending third-year students of UCLA Medical School were surveyed to assess their self-perceived competency and training in performing clinical breast, Pap smear, digital rectal, and skin cancer examinations. Analysis of variance was conducted to compare the differences in competency ratings. Multiple regression analysis was applied to identify predictors of competency. RESULTS: Fifty-two (67%) of the 78 third-year medical students sampled participated in the study. They reported being least (p < 0.001) competent in performing skin cancer examinations. The number of times practicing screening examinations was the most significant (p < 0.001) educational predictor for self-reported competency in every area except skin cancer. More practice is needed in each screening exam before students feel somewhat or extremely competent. CONCLUSION: Student hands-on experience is crucial in the development of cancer screening competency.