The decline in physical examination skills of US graduates has been documented and lamented for a number of years.  While there are many reasons proposed, the compression of time resulting from increased clinical demands and the availability of tests that will (at least in the young physicians’ minds) yield more accurate information are among the most prominent.  In their article in Yale Medicine the authors present a case in which a simple physical maneuver saved a young man from a potential lifetime of anticoagulation (http://yalemedicine.yale.edu/winter2009/features/feature/51079). 

 While there have been a number of suggestions on techniques to improve the teaching of clinical skills such as using video clips of correct techniques (http://www.stfm.org/fmhub/fm2008/July/Eugene471.pdf) perhaps the most effective document was the report by the AAMC, the body that accredits US medical schools that set our a set of recommendations as to the requirements for clinical skills’ teaching and evaluation.  This can be downloaded at https://www.aamc.org/download/130608/data/clinicalskills_oct09.qxd.pdf.pdf. 

These recommendations have now been incorporated into the US licensing examination that all physicians must pass in order to become licensed in any state in the US.  The examination how incorporates section 2-CS.  All candidates go to one of five centers where they are present 12 simulated patients.  They have 15 minutes each to take a history, do a physical examination, communicate their impressions with the simulated patient and write notes (http://en.wikipedia.org/wiki/United_States_Medical_Licensing_Examination). They are scored on data gathering, physical examination, physician-patient communication and note writing (http://www.usmle.org/step-2-cs/#scoring ). 

 At Indiana University School of Medicine the curriculum is competency based and the students must progress in their competencies as they progress though medical school(http://medicine.iu.edu/ume/curriculum/competencies/).

A parallel major development in medical education in the US has been the establishment of simulation centers where clinical skills and diagnostic and therapeutic interventions can be taught and evaluated.  Indiana University has one of the largest and most comprehensive of such centers, which can be toured virtually at

http://iuhealth.org/health-professionals/physician-education/simulation-center/.

Every student at Indiana University must demonstrate his or her clinical skills with simulated patients based upon the USMLE 2-CS process in order to graduate.  Thus current US graduates know how to perform a physical examination.  Time will tell whether or not they continue to apply these skills as try progress trough their training and enter practice.