Background Medical students rarely have the opportunity to learn and practice tactful history taking and delicate counseling skills critical to adolescent health. The purpose of this study is to determine the impact of an adolescent medicine (AM) workshop (WS) using standardized patients (SP) on knowledge and skills of third-year medical students.
Methods A 4-hour AM WS was developed as part of a new curriculum for a required third-year medical school 4-week primary care internal medicine clerkship and randomized for delivery to half of the rotational groups. The WS incorporates four SP cases representing different clinical challenges (sexual history, depression/suicide, risky behavior, and smoking cessation). A faculty preceptor facilitates group discussion of sensitive approaches to the problems. Participating students are also provided a 26-page AM reference. All students in every rotation group are assigned AM readings. At the end of the 4 weeks, all students take a 100-item written examination (six AM questions) and nine-station SP examination (one AM station), including a post-SP encounter open-ended written exercise. Scores on the written examination AM questions, AM SP checklist items, and AM open-ended written exercise of workshop participators and nonparticipators were analyzed with simple means, standard deviations, and multiple regression approaches controlling for performance on a preventative medicine station and USMLE scores.
Results The AM WS was delivered to 12 of the 24 rotation groups during the 2004-2006 academic years. Ninety-five students participated in the WS and 91 did not. WS participants performed significantly better than nonparticipants on the AM SP checklist (36.3 ± 0.6.1 vs 27.5 ± 0.6.7, F = 89.9, p < .0001), the postencounter written exercise (12.4 ± 3.0 vs 10.5 ± 2.7, F = 19.5, p < .0001), and the six written examination AM items (4.5 ± 1.0 vs 4.1 ± 1.2, F = 9.4, p = .003).
Conclusions Students participating in a 4-hour SP workshop exhibit superior AM clinical skills as assessed by SP clinical examination, open-ended written exercise, and AM-specific items on a written examination. Simulation with SPs appears to be an ideal medium for teaching high-stakes clinical skills. There findings lend additonal support to the theory that there are unique aspects to caring for adolescent patients that might be better taught using an interactive pedagogy.
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