A cross sectional study of the relationship between clinical scores and timing of guidance for resident physicians in outpatient settings

Receiving teaching in clinical practice is essential for improving resident physicians' clinical reasoning skills. However, the frequency and usefulness of teaching at each stage of outpatient clinical courses remain unclear. Furthermore, the relationship between the timing of teaching and clinical skills has not been clearly established. This analytical cross-sectional study was conducted among residents taking the General Internal Medicine Intermediate Training Examination (GM-ITE^®). Using a structured questionnaire, residents' sociodemographic characteristics, clinical training content, and GM-ITE^® scores were obtained. Additionally, the survey comprised questions regarding participants' experiences and the usefulness of teaching during five clinical stages: medical interview, physical examination, patient assessment, decision-making, and consultation. The analysis included 4,662 residents. Teaching was most frequently provided during the decision-making and patient assessment stages. However, only 59.4% of teaching was provided during the medical interview stage. The perceived usefulness of teaching was the highest during the decision-making stage, and more than 90% of respondents rated teaching as "very useful" or "useful" during all stages. Furthermore, teaching decision-making during clinical training was highly useful for residents and related to higher clinical scores. Conversely, teaching physical examination during clinical training was related to lower clinical scores.