Can specialists and generalists teach clinical skills to second-year medical students with equal effectiveness?

PURPOSE: To compare the effectiveness of specialists and generalists as small-group leaders teaching basic physical examination skills to preclinical medical students. METHOD: Specialists and generalists were randomly assigned to teach physical examination skills to 69 groups of second-year students (n = 288). At the conclusion of the course, the specialist- and generalist-led groups were compared using three measures: students' scores on an objective structured clinical exam (OSCE), students' evaluations of their small-group leaders, and leaders' self-evaluations of confidence in teaching. RESULTS: OSCE scores did not differ between students taught by specialists and generalists (93.5% and 93.8% respectively, p = NS). Students' evaluations of their leaders were similar for nine characteristics rated on a seven-point scale (7 = strongly agree/outstanding; range of results for specialists: 6.20-6.62, for generalists 6.34-6.75, p = NS). Leaders expressed similar levels of confidence (on a seven-point scale; 7 = very confident) in their abilities to teach the neurologic exam (specialists 5.52, generalists 6.19, mean effect size difference 0.44, p = NS) and complete history and physical exam (6.03 and 6.53, mean effect size difference 0.43, p = NS). Specialists were significantly less confident in teaching the cardiovascular exam (5.80 and 6.50, mean effect size difference 0.51, p <.05) and pulmonary exam (5.56 and 6.60, mean effect size difference, 0.80, p <.01). CONCLUSIONS: Specialists and generalists can teach preclinical medical students with equal effectiveness as rated by the students and the students' scores on the OSCE examination, but specialists do not rate themselves as confident as do generalists to teach some skills.