BACKGROUND: Few studies use objective structured clinical examinations (OSCEs) to measure physical examination skills of internal medicine residents. Little is known about performance by year of residency training. PURPOSE: To determine differences between postgraduate year (PGY)-1 and PGY-3 residents on performance and comfort of physical examination skills. METHODS: In a cross-sectional study, we tested 16 PGY-1 (weeks 0 and 4) and 8 PGY-3 internal medicine residents with a five-station OSCE. RESULTS: PGY-3 residents performed better than PGY-1 week 0 residents (P = 0.03) but not PGY-1 week 4 residents (P = 0.42). PGY-1 resident performance improved after 1 month of inpatient wards experience (P < 0.001). PGY-3 residents had higher comfort compared to PGY-1 week 0 residents (P = 0.003) but not PGY-1 week 4 residents (P = 0.10). CONCLUSIONS: Senior residents performed better and were more confident on physical examination skills, but the difference disappeared after 1 month of internship. This calls into question how much further learning occurs with physical examination throughout residency training. © Copyright 2007 Southern Society for Clinical Investigation.