2011 - UCSF School of Medicine - University of California, San ...

UCSF Education Day 2011standardized patient examination.Background: Risk behaviors tend to cluster andsmokers in particular are likely to engage in multiplerisks. Treating multiple risk behaviors improves patienthealth outcomes and reduces health care costs.Methods: Using a randomized experimental design,medical students’ counseling interactions wereevaluated with a standardized patient presenting withsexual health concerns and current tobacco use withvaried problematic drinking status (alcohol-positive oralcohol-negative). Participants were 156 third yearmedical students at the University of California, SanFrancisco. Checklists completed by standardizedpatients evaluated students’ clinical performance. Afterthe encounter, students completed surveys of theirknowledge and attitudes for treating smokers withalcohol problems.Results: Overall, most students assessed tobacco use(85%); fewer assessed alcohol use (54%). Relative tothe alcohol-negative case, students seeing the alcoholpositivecase were less likely to assess STD history(80% vs. 91%, χ2(1)=4.15, p=.042) or patients’readiness to quit smoking (41% vs. 60%, χ2(1)=5.01,p=.025) and endorsed greater attitudinal barriers totobacco treatment, F(1,155)=4.79, p=.030. Patientsatisfaction, expressed as willingness to continuemedical treatment with the student doctor, wassignificantly lower for the alcohol-positive than thealcohol-negative case, χ2(1)=5.18, p=.023. Clinicalperformance ratings moderated the relationship betweenpatient case version and patient satisfaction.Discussion: When presented with a case of multiplerisk behaviors (sexual health, tobacco and alcohol),medical students performed less effectively and receivedlower patient satisfaction ratings than with a caseinvolving fewer behavioral risks. Findings weremoderated by ratings of students’ overall clinicalperformance.Reflective critique: The findings support the need forparadigm shifts in medical education that emphasizeassessment of multiple risks, new models ofconceptualizing behavior change as a generalizedprocess, and treatment of the whole patient foroptimizing health outcomes.Physical Examination Teaching: ASystematic Review of the LiteratureSomnath Mookherjee, MD, UCSF, Department ofMedicine, Division of Hospital Medicine,SMookherjee@medicine.ucsf.edu; Lara Pheatt, MA,UCSF School of Medicine, Office of Medical Education,PheattL@medsch.ucsf.edu; Calvin L. Chou, MD, PhD,UCSF and VA Department of Medicine, Division ofGeneral Internal Medicine, calvin.chou@ucsf.eduAreas abstract covers: UME, GME, CMEDomain(s) addressed: Clinical Instruction andPerformance, Evaluation of Programs and Curricula,Patient CarePurpose: To review physical examination (PE) teachingmethods studied in the literature, summarize findings,and recommend best practices.Background: Physicians must be competent in the“synthesis” of PE data to make optimal patient caredecisions. Recent reports have bemoaned theinadequacy of physicians' PE skills; however, mostschools teach a comprehensive PE without links topatient care. Therefore, PE education needsimprovement, but the most effective teaching methodsare unknown.Methods: We included all publications of PE teachingpublished from 1951-2011 that studied the effects of acurricular intervention and reported on teaching efficacy.Data extracted included organ system targeted, studydesign, types of curricula, measurements of efficacy,and domains of PE learning (psychomotor skills,knowledge, communication, and “synthesis” of data intoclinical application).Results: Of 3665 papers retrieved, 121 met inclusioncriteria. The most represented organ systems werecardiovascular, musculoskeletal, gynecological, andgeneral (multiple organ systems or comprehensive PE).Sixty-six (55%) studies included control groups. Majorcategories of educational interventions includedsimulation with standardized patients (SPs), simulationof aspects of PE (such as recordings of heart sounds),bedside teaching, and peer examination or tutoring.Common assessment methods included checklists withobserved structured clinical examinations, written tests,and surveys of learner satisfaction and self-assessedcompetence. Psychomotor skills and knowledgeacquisition were the most common competenciestargeted; seventeen papers (14%) were judged to teachPE in the “synthesis” realm.Discussion: Despite heightened awareness of theimportance of PE skills in guiding patient care, we foundfew curricula that taught PE “synthesis.” Heterogeneity inUniversity of California, San Francisco • School of Medicine 37