Are medical students confident in assessing the patient presenting with a neck lump?

Abstract

Neck lumps are a common clinical presentation in both primary care, the emergency department and in specialist clinics. Foundation doctors and final year medical students are often not confident in the assessment of patients presenting with head and neck symptoms. We evaluated medical students confidence in performing a systematic neck lump examination, formulation of differential diagnosis and presentation to senior colleagues. An online survey was completed by 185 medical students across two English Universities; 122 (66.0%) students were from University A and 63 (34.0%) students were from University B. Students were in their third-fifth year of medical school. 98.4% (n=182) of participants reported receiving formal teaching of neck lump examination during medical school for the 66.0% (n=122) of medical students were confident in examining a neck lump but 62.4% (n=115) were not confident in presenting examination findings to a senior colleague. Totals of 78.4% (n= 145) and 64.8% (n=120) did not feel confident in generating a list of differential diagnoses for a patient with an anterior or posterior neck lump, respectively. A total of Despite being able to examine neck lumps, medical students did not feel confident in presenting their examination findings or proposing differential diagnoses. This may be due to superficial understanding and poor knowledge translation into clinical practice. Use of a lymphadenopathy simulator, the teaching of common malignancies and corresponding head and neck lymph node drainage may improve diagnostic reasoning and aid early detection of cancer and other conditions.