A Clinical Performance Exercise for MedicinePediatrics Residents Emphasizing Complex Psychosocial Skills

Duke, Mary B. MD; Griffith, Charles H. III MD, MSPH; Haist, Steven A. MD, MS; Wilson, John F. PhD

Academic Medicine:
Educating Physicians: Research Reports
Abstract

Purpose. To assess the skills of internal medicine—pediatrics (med—peds) residents in evaluating and counseling patients with complex psychosocial problems using a clinical performance exercise (CPE).

Method. The authors designed a 13-station CPE [nine standardized-patient (SP) stations and four non-SP stations]. Eight of the SP stations focused on counseling or assessing complex psychosocial needs, and three were videotaped and analyzed for specific verbal and nonverbal communication skills. Residents completed a written task for each station and SPs completed a checklist on interviewing and communication skills and a 52-item patient's-satisfaction survey. All first- and third-year residents (n = 25) from two academic years participated.

Results. The range of the average scores on the nine SP stations was 43–75%. The residents performed better with common problems (newborn hospital discharge instructions and cardiac risk-factor counseling) than with more complex problems that are less often encountered in the institution (HIV counseling), or problems less often recognized (adult survivor of childhood sexual abuse). As expected, third-year residents scored better than did first-year residents on the written “plan” part of the SP stations and on the non-SP stations. Third-year and first-year residents had similar scores, however, on measures of verbal and nonverbal communication and patient's satisfaction, and for gathering data and providing information.

Conclusion. This is the first performance-based evaluation of residents in a combined med—peds residency program. The stations addressed more complex clinical skills than those reported for objective structured clinical evaluations of residents.

Author Information

Dr. Duke is associate professor, Dr. Griffith is associate professor, and Dr. Haist is professor, Division of General Internal Medicine, and Dr. Wilson is professor, Department of Behavioral Science. All are at the University of Kentucky College of Medicine, Lexington.

Correspondence and requests for reprints should be addressed to Dr. Duke, K512 Kentucky Clinic, University of Kentucky 740 S. Limestone, Lexington, KY 40536-0284; e-mail: 〈mbduke2@uky.edu〉.

This project was supported in part by a Residency Training in Internal Medicine/Pediatrics grant from the Health Resources and Services Administration and does not necessarily reflect the opinion or policies of the Health Resources and Services Administration.

© 2001 Association of American Medical Colleges