RESULTS: Mean humanism scores were lowest for students who scored in the most physiciancentered quartile (79.6 9.4) and highest for students who scored in the most patient-centered quartile (83.4 7.0) on PPOS. In linear regression analysis controlling for month of the thirdyear on the primary care clerkship, patient-centered PPOS scores (p=.01) and female gender (p=.05) were found to be associated with higher total humanism scores. CONCLUSION: Student physicians with more patient-centered attitudes demonstrated higher degrees of humanism as perceived by standardized patients. Patients' perceptions of humanism were also influenced by student gender. Further research is needed to explore the nature of associations between physicians' attitudes and patients' perceptions of care, as well as the impact of medical education on students' attitudes toward the physician-patient relationship. PURPOSE: Although training in the skills required to perform pelvic examinations is ubiquitous in medical schools, few residency programs assess or reinforce these skills, and only limited evidence justifies the substantial cost of post-graduate training. We report results of a controlled study of training for Internal Medicine interns utilizing professional instructors who also serve as models for the exam. METHODS: 48 interns from two university Internal Medicine residencies completed questionnaires about their experiences with pelvic examinations. 23 participated in a two-hour training session after which their skills were assessed. At follow-up four months later, the skills of 13 of the trained interns were compared with that of 24 interns who had not been trained. Assessments were based on the observation of verifiable behaviors. Chi-square tests were used to assess the statistical significance of comparisons. Inter-rater reliability was assessed with the kappa statistic. RESULTS: Mean age of the 37 interns in the controlled study was 28.4 (range 24-40), with 57% women and 89% graduates of U.S. medical schools. 70% of the interns described having received specific pelvic exam skills training in medical school, 78% felt comfortable performing the exam, and 91% felt they give patients clear instructions. Interns who participated in the current training displayed 10 of 12 key behaviors more frequently when compared with interns who had not been trained. Overall, trained interns demonstrated 87% of key behaviors, compared with 63% for untrained interns. Specific items for which the largest improvements occurred were in providing an outline of the exam (100% for trained interns vs. 38% for those not trained) and explicitly giving permission to ask questions (69% vs.17%; p < 0.01 for all three comparisons). Independent video and in-person observers agreed well with ratings of instructors (kappas > 0.7). CONCLUSION: Most interns described exposure to medical school pelvic examination training, but many overestimated their skills. A program employing professional trainers can reliably evaluate and improve key skills and improvements are demonstrable months after training. Further work is needed to demonstrate consistent benefits in larger groups of interns and residents, to ascertain whether training efficiency could be improved, and to measure the impact of training on subsequent encounters with actual patients. The mini-CEX can facilitate interactive feedback (FB) between faculty and residents to help residents correct deficiencies and reinforce good clinical skills. However, little is known about the nature of the FB that results after a mini-CEX is completed, and whether the FB is interactive. PURPOSE: To assess how frequently interactive FB is given after completion of a mini-CEX with PGY-1s in an outpatient setting. METHODS: Prospective cohort study of mini-CEXs performed with PGY-1s in the outpatient setting at three internal medicine residency programs: Yale University Primary Care, Washington Hospital Center, and the National Naval Medical Center. Feedback sessions were audiotaped after completion of the mini-CEX. All tapes were transcribed with all identifying information deleted. Transcripts were independently coded by two investigators (ESH, SH). Disagreements were resolved by consensus. Interactive FB was defined as: a) any recommendation(s) given to the PGY-1s; b) PGY-1s were asked to self-assess their mini-CEX performance (self-assessment); c) PGY-1s were given an opportunity to react to the FB (learner reaction); d) and faculty stated a specific plan to change PGY-1's future performance (action plan). RESULTS: For this preliminary analysis, 30 attendings provided FB sessions to 41 different PGY-1s at the 3 residency programs. Fifty sessions have been transcribed and analyzed. Forty-five (95%) FB sessions included at least one recommendation. The median number of recommendations per session was 2 (range 0-9). Recommendations were given most commonly for communication skills, notably patient interviewing (31 sessions, 62%) and counseling (21 sessions, 42%). Feedback on components of the physical exam was given in 13 sessions (26%). Attendings asked PGY-1s to self-assess performance in 19 sessions (38%) and to specifically respond to the FB (learner reaction) in 32 sessions (64%). Despite the high frequency of recommendations, only 3 sessions (6%) included an attending's discussion for an action plan to help the PGY-1 correct noted deficiencies. CONCLUSION: For this cohort, the mini-CEX effectively generated recommendations to improve clinical performance, especially in communication skills, and the majority of attendings asked PGY-1s to react to the FB. However, programs planning to use the mini-CEX should also consider strategies to encourage their faculty to provide more FB on other observed skills, promote more self-assessment, and establish definitive action plans to correct deficiencies.