Carol A. Pfeiffer

DOWNWARD COMPARISON AND COPING WITH SERIOUS MEDICAL PROBLEMS

Correlates of selective comparisons by mothers of high-risk infants and individuals with rheumatoid arthritis showed that mothers were especially likely to make downward comparisons. Arthritis patients making downward comparisons were rated by their health care providers as more positively adjusted, independent of actual severity of illness. Implications for support providers are discussed.

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward ones illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Evaluation of Online Instruction to Improve Medical and Dental Students’ Communication and Counseling Skills

Online, interactive video modules were created to demonstrate good skills in history taking, counseling, and communication. The authors evaluated the effect of the modules on students’ data gathering, counseling, and communication skills with standardized patients (SPs). A student cohort without the online modules (n = 76 medical students and n = 43 dental students) was compared to a cohort of different students who were assigned the modules (n = 88 medical students and n = 39 dental students). Students were evaluated by SPs using case-specific content checklists and the Master Interview Rating Scale (MIRS). Compared to their counterparts who did not use the modules, medical and dental students who used the modules showed significantly higher performance on several outcomes. The areas that showed benefit were those that were novel to students. Student accuracy in grading others was generally unrelated to their own performance. In conclusion, the online, interactive video modules were associated with improvements in a majority of clinical skills.

Face-to-Face Clinical Skills Feedback: Lessons From the Analysis of Standardized Patient' Work

Background: Current evidence suggests that trainees are evaluated less stringently when feedback is given face-to-face, limiting its value. Purpose: We expected that standardized patients (SPs) would also be more lenient in scoring when they gave immediate feedback to the students. Methods: Data from 6 clinical skills assessments of students in Years 1 to 4 of medical school were used. Comparisons in scoring were made for the cases on which students received feedback and those where they did not. Analysis was done using a hierarchical linear regression model to test for significant differences. Results: The results indicated no significant difference in scoring for the history and physical exam checklists. There was a small but significant difference on the measure of interpersonal and interviewing skills. Conclusions: The SPs were trained to avoid stringency, leniency, and restricted range in scoring students. These training methods may be useful for training faculty to give face-to-face feedback.

Long-term Retention of Smoking Cessation Counseling Skills Learned in the First Year of Medical School

BackgroundTobacco use is a significant cause of preventable morbidity and mortality in the United States, yet clinicians underutilize smoking cessation counseling. Medical schools are increasingly including training for smoking cessation skills in preclinical curricula. Information about long-term retention of these skills is needed.ObjectiveTo assess retention of smoking cessation counseling skills learned in the first year of medical school.DesignRetrospective review of data collected for routine student and curriculum assessment.ParticipantsTwo cohorts of medical students at the University of Connecticut School of Medicine (total N = 112) in 1999–2001 and 2002–2004.Measurements and Main ResultsScores by standardized patients were compared from first and fourth-year assessments, based on checklist items corresponding to the 5 strategies recommended by the U.S. Public Health Service (Ask, Advise, Assess, Assist, Arrange). In study cases, 97% of first-year students “asked” about smoking and retained this skill in fourth year (p = .08). Ninety-four percent of first-year students “assessed” readiness to quit and retained this skill (p = .21). Ninety-six percent of first-year students “advised” smokers to quit and retained this skill (p = .18). Eighty-six percent of first year students “assisted” smokers in quitting and retained this skill (p = 0.10). Eighty-one percent of first year students “arranged” follow-up contact and performance of this strategy improved in the fourth year to 91% (p = .03).ConclusionsSmoking cessation counseling skills demonstrated by first year medical students were, with brief formal reinforcement in the third year, well retained into the fourth year of medical school. It is appropriate to begin this training early in medical education.

Teaching patient wellness to first‐year medical students: the impact on future ability to perform the history of present illness

Curriculum innovations to improve clinical skills have been implemented at many American medical schools. A current curricular change at the University of Connecticut School of Medicine involves teaching wellness to students in the first year rather than the more traditional focus on disease processes. It is unknown, however, if focusing on wellness detracts from students’ future ability to perform the history of present illness (HPI) which requires students to focus on disease processes.

Reinforcement of occupational history taking: a success story.

Background: This article describes the results of a retrospective study of 3 classes of medical students who participated in a targeted occupational and environmental health curriculum at the University of Connecticut School of Medicine. Purpose: We wanted to determine if targeted focused curricular interventions which integrated occupational and environmental health principles into routine history taking would result in increased scores on the number of questions posed during the Clinical Skills Assessment Program in the 4th year. Methods: We analyzed Clinical Skills Assessment Program questions for 3 graduating medical school classes from 1997 to 1999. Results: It appears that intense, focused training may increase the occupational and environmental questions which students ask. By revisiting the components of the history during the 3rd year, the final assessment of 4th-year students substantially and significantly increased. Conclusions: Those who wish to stem the decline in history-taking skills as students enter their clinical years should consider reinforcing these skills using structured programs and practice in areas of the history that are traditionally neglected but recognized as essential in gathering comprehensive data on patients.

Impact of the Site Specialty of a Continuity Practice on Students' Clinical Skills: Performance With Standardized Patients

Background: The assessment of clinical competence and the impact of training in ambulatory settings are two issues of importance in the evaluation of medical student performance. Purpose: This study compares the clinical skills performance of students placed in three types of community preceptors’ offices (pediatrics, medicine, family medicine) on yearly clinical skills assessments with standardized patients. Our goal was to see if the site specialty impacted on clinical performance. Methods: The students in the study were completing a 3-year continuity preceptorship at a site representing one of the disciplines. Their performance on the four clinical skills assessments was compared. Results: There was no significant difference in history taking, physical exam, communication, or clinical reasoning in any year (ANOVA p⩽ .05) There was a small but significant difference in performance on a measure of interpersonal and interviewing skills during Years 1 and 2. Conclusion: The site specialty of an early clinical experience does not have a significant impact on performance of most of the skills measured by the assessments.

Teens as Teachers: Improving Recruitment and Training of Adolescent Standardized Patients in a Simulated Patient Encounter

Background: Studies in medical education have reliably established the importance of utilizing adolescents as standardized patients. Their realistic portrayals offer authentic learning experiences. Additionally, the curricula can offer the adolescent participants a meaningful educational opportunity. Methods: The “Teens as Teachers” program was developed at the University of Connecticut, School of Medicine, to prepare second year medical students to interview, elicit a history and address issues related to risk behaviors in adolescent standardized patients. In addition, the program offers educational and mentoring opportunities for the teenaged participants. Results: The twenty-four adolescents trained as standardized patients have worked with 359 second year medical students. Results reveal that the adolescents felt the training adequately prepared them for their cases, found the overall experience rewarding and 100% of the adolescents would return to participate if possible. 88.6% of medical students rated the cases authentic, 98.8% found then valuable, 94.2% were able to practice the skills learned during lecture and 96.8% received feedback from the adolescent standardized patients. Conclusion: Utilizing adolescent standardized patients to teach interviewing skills to medical students can prepare them to elicit comprehensive histories and can be a beneficial learning experience for the teenaged participants.

The Use of Standardized Patient Encounters for Evaluation of a Clinical Education Program on the Development of HIV/AIDS-Related Clinical Skills

Abstract The success of medical education is traditionally gauged by performance on written examinations. However, clinical proficiency in real-world situations is difficult to assess by written examinations alone. We developed a novel evaluation tool to measure the development of HIV-specific clinical skills using Standardized Patient Encounters (SPEs). Trainees were evaluated at baseline and after an HIV clinical training module by (1) self-reported confidence with HIV-specific clinical skills and (2) performance assessments using SPEs. Case scenarios were designed to incorporate unique issues associated with HIV that may present to a primary care provider. SPEs were scored based on written documentation including problem list and plan as well as a review of the videotapes by HIV specialists evaluating key elements of clinical skills and decision making. Improvements were noted in multiple facets of the encounters. The use of SPEs enables evaluation of clinical training interventions on the development of HIV-related clinical skill sets.