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Teaching about substance abuse with objective structured clinical exams

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Abstract

BACKGROUND: Although residents commonly manage substance abuse disorders, optimal approaches to teaching these specialized interviewing and intervention skills are unknown.

OBJECTIVE: We developed a Substance Abuse Objective Structured Clinical Exam (OSCE) to teach addiction medicine competencies using immediate feedback. In this study we evaluated OSCE performance, examined associations between performance and self-assessed interest and competence in substance abuse, and assessed learning during the OSCE.

DESIGN: Five-station OSCE, including different substance abuse disorders and readiness to change stages, administered during postgraduate year-3 ambulatory rotations for 2 years.

PARTICIPANTS: One hundred and thirty-one internal and family medicine residents.

MEASUREMENTS: Faculty and standardized patients (SPs) assessed residents’ general communication, assessment, management, and global skills using 4-point scales. Residents completed a pre-OSCE survey of experience, interest and competence in substance abuse, and a post-OSCE survey evaluating its educational value. Learning during the OSCE was also assessed by measuring performance improvement from the first to the final OSCE station.

RESULTS: Residents performed better (P<.001) in general communication (mean ± SD across stations =3.12±0.35) than assessment (2.65±0.32) or management (2.58±0.44), and overall ratings were lowest in the contemplative alcohol abuse station (2.50±0.83). Performance was not associated with residents’ self-assessed interest or competence. Perceived educational value of the OSCE was high, and feedback improved subsequent performance.

CONCLUSIONS: Although internal and family medicine residents require additional training in specialized substance abuse skills, immediate feedback provided during an OSCE helped teach needed skills for assessing and managing substance abuse disorders.

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References

  1. Weaver MF, Jarvis MAE, Scholl SH. Role of the primary care physician in problems of substance abuse. Arch Intern Med. 1999;159:913–24.

    Article  PubMed  CAS  Google Scholar 

  2. Cleary PD, Miller M, Bust BT, Warburg MM, Delbanco TL, Aronson MD. Prevalence and recognition of alcohol abuse in a primary care population. Am J Med. 1988;85:466–71.

    Article  PubMed  CAS  Google Scholar 

  3. Lewis DC. The role of internal medicine in addiction medicine. J Addictive Dis. 2001;15:1–17.

    Article  Google Scholar 

  4. Fiellin DA, Reid MC, O’Connor PG. Screening for alcohol problems in primary care: a systematic review. Arch Intern Med. 2000;160:1977–89.

    Article  PubMed  CAS  Google Scholar 

  5. Stimmel B, Cohen D, Colliver J, Swarz M. An assessment of house staff’s knowledge of alcohol and substance abuse utilizing standardized patients. Subst Abus. 2000;21:1–7.

    Article  PubMed  Google Scholar 

  6. Fleming M. Competencies for substance abuse training. In: Lewis DC, Sirca C, eds. Training About Alcohol and Substance Abuse for all Primary Care Physicians. New York: Josiah Macy Jr. Foundation; 1990:213–47.

    Google Scholar 

  7. Fleming MF, Manwell LB, Kraus M, Isaacson JH, Kahn R, Stauffacher EA. Who teaches residents about the prevention and treatment of substance abuse disorders? A national survey. J Fam Prac. 2001;48:725–9.

    Google Scholar 

  8. Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd edn. Alexandria, Va: International Medical Publishing; 1996.

    Google Scholar 

  9. U.S. Preventive Services Task Force. Screening and behavioral counseling in primary care to reduce alcohol misuse: recommendation statement. Ann Intern Med. 2004;140:554–6.

    Google Scholar 

  10. Isaacson JH, Fleming M, Kraus M, Kahn R. A national survey of training in substance use disorders in residency programs. J Stud Alcohol. 2000;61:912–5.

    PubMed  CAS  Google Scholar 

  11. Fiellin DA, Butler R, D’Onofrio G, Brown R, O’Connor P. The physician’s role in caring for patients with substance abuse disorders: implications for medical education and training. In: strategic plan for interdisciplinary faculty development. Subst Abus. 2002;(suppl 23):S207–22.

  12. Zyromski NJ, Starten ED, Merrick HW. Surgery residents’ perception of the objective structured clinical exam (OSCE). Curr Surg. 2003;60:533–7.

    Article  PubMed  Google Scholar 

  13. Harden RM, Gleason FA. Assessment of clinical competence using an objective structured clinical examination. Med Educ. 1979;13:41–7.

    PubMed  CAS  Google Scholar 

  14. Anderson MB, Stillman PL, Wang Y. Growing use of standardized patients in teaching and evaluation in medical education. Teach Learn Med. 1994;6:15–22.

    Article  Google Scholar 

  15. Sloan DA, Plymale MA, Donnelly MB, Schwartz RW, Edwards MJ, Bland KI. Enhancing the clinical skills of surgical residents through structured cancer education. Ann Surg. 2004;239:561–6.

    Article  PubMed  Google Scholar 

  16. Carraccio C, Englander R. The objective structured clinical examination: a step in the direction of competency-based evaluation. Arch Pediatr Adolesc Med. 2000;154:736–41.

    PubMed  CAS  Google Scholar 

  17. Hodder RV, Rivington RN, Calcutt LE, Hart IR. The effectiveness of immediate feedback during the objective structured clinical examination. J Med Educ. 1989;23:184–8.

    Article  CAS  Google Scholar 

  18. Sloan DA, Donnelly MB, Schwartz RW, Felts JL, Blue AV, Strodel WE. The use of objective structured clinical examination (OSCE) in for evaluation and instruction in graduate medical education. J Surg Res. 1996;63:225–30.

    Article  PubMed  CAS  Google Scholar 

  19. Wilson BE. Performance-based assessment of internal medicine interns: evaluation of baseline clinical and communication skills. Acad Med. 2002;77:1158.

    Article  PubMed  Google Scholar 

  20. Dupras DM, Li JT. Use of an objective structured clinical examination to determine clinical competence. Acad Med. 1995;70:1029–34.

    Article  PubMed  CAS  Google Scholar 

  21. Hilliard RI, Tallet SE. The use of an objective structured clinical examination with postgraduate residents in pediatrics. Arch Pediatr Adolesc Med. 1998;152:74–8.

    PubMed  CAS  Google Scholar 

  22. Jain SS, Nadler S, Eyles M, Kirshblum S, DeLisa JA, Smith A. Development of an objective structured clinical examination for physical medicine and rehabilitation residents. Am J Phys Med Rehabil. 1997;76:102–6.

    Article  PubMed  CAS  Google Scholar 

  23. Hanson M, McNaughton N, Regehr G. Creating, monitoring, and improving a psychiatry OSCE: a guide for faculty. Acad Psychiatry. 2002;26:134–61.

    Article  PubMed  Google Scholar 

  24. Hodges B, Regehr G, Hanson M, McNaughton N. An objective structured clinical examination for evaluation psychiatric clerks. Acad Med. 1997;72:715–21.

    Article  PubMed  CAS  Google Scholar 

  25. Skinner BD, Newton WP, Curtis P. The educational value of an OSCE in a family practice residency. Acad Med. 1997;72:722–4.

    Article  PubMed  CAS  Google Scholar 

  26. Amiel GE, Ungar L, Alperin M. Using an OSCE to assess primary care physicians’ competence in breaking bad news. Acad Med. 2000;75:560–1.

    Article  PubMed  CAS  Google Scholar 

  27. Aronson SG, Kirby RW. Improving knowledge and communication through an advanced care directives objective structured clinical examination. J Palliat Med. 2002;5:916–9.

    Article  PubMed  Google Scholar 

  28. Altshuler L, Kachur E. A culture OSCE: teaching residents to bridge different worlds. Acad Med. 2001;76:514.

    Article  PubMed  CAS  Google Scholar 

  29. Singer PA, Cohen R, Robb A, Rothman A. The ethics objective structured clinical examination. J Gen Intern Med. 1993;8:23–8.

    Article  PubMed  CAS  Google Scholar 

  30. Kahan K, Wilson L, Midmer D, Borsoi D, Martin D. Randomized controlled trial on the effects of a skills-based workshop on medical students’ management of problem drinking and alcohol dependence. Subst Abus. 2003;24:5–16.

    Article  PubMed  Google Scholar 

  31. Matthews J, Kadish W, Barrett SV, Mazor K, Field D, Jonassen J. The impact of a brief interclerkship about substance abuse on medical students’ skills. Acad Med. 2002;77:419–26.

    Article  PubMed  Google Scholar 

  32. Kahan M, Wilson L, Midmer D, Borsoi D, Martin D. Randomized controlled trial on the effects of a skills-based workshop on medical students’ management of problem drinking and alcohol dependence. Subst Abus. 2003;24:5–16.

    Article  PubMed  Google Scholar 

  33. Levin FR, Owen P, Stinchfield R, Rabinowitz E, Pace N. Use of standardized patients to evaluate the physician’s in residence program: a substance abuse training approach. J Addict Dis. 1999;18:39–50.

    PubMed  CAS  Google Scholar 

  34. Wilk AI, Jensen NM. Investigation of a brief teaching encounter using standardized patients: teaching residents alcohol screening and intervention. J Gen Intern Med. 2002;17:356–60.

    Article  PubMed  Google Scholar 

  35. Farber NJ, Urban SY, Collier VU, Metzger M, Weiner J, Boyer EG. Frequency and perceived competence in providing palliative care to terminally ill patients: a survey of primary care physicians. J Pain Symptom Manag. 2004;28:364–72.

    Article  Google Scholar 

  36. Robinson BE, Barry PP, Renick N, Bergen MR, Stratos GA. Physician confidence and interest in learning more about common geriatric topics: a needs assessment. J Am Geriatr Soc. 2001;49:963–7.

    Article  PubMed  CAS  Google Scholar 

  37. Prochaska JO, DiClemente CC, Norcross JC. In search of how people change: applications to addictive behaviors. Am Psychol. 1992;47:1102–14.

    Article  PubMed  CAS  Google Scholar 

  38. Samet JH, O’Connor P. Alcohol abusers in primary care: readiness to change behavior. Am J Med. 1998;105:302–6.

    Article  PubMed  CAS  Google Scholar 

  39. Stimmel B, ed. Utilizing Standardized Patient Protocols To Improve Clinical Skills in Identifying Tobacco, Alcohol and Other Drug Use. New York: Josiah Macy Jr. Foundation; 1998.

    Google Scholar 

  40. Zabar S, Hanley K, Stevens D, et al. Measuring competence of residents and teachers. J Gen Intern Med. 2004;19:530–3.

    Article  PubMed  Google Scholar 

  41. Saitz R. Unhealthy alcohol use. N Engl J Med. 2005;352:596–607.

    Article  PubMed  CAS  Google Scholar 

  42. Rollnick S, Mason P, Butler C. Health Behavior Change: A Guide for Practitioners. Edinburgh: Churchill Livingston; 2000:185–97.

    Google Scholar 

  43. Hodges B, Regehr G, Martin Difficulties in recognizing one’s own incompetence: novice physicians who are unskilled and unaware of it. Acad Med. 2001;76(suppl 10):S87–9.

    Article  PubMed  CAS  Google Scholar 

  44. Khan J, Rooney K, Prosiak C, Javadpoor A, Rooney PJ. Effect of immediate feedback on performance at subsequent stations during an objective structured clinical examination. Educ Health. 1997;10:351–7.

    Google Scholar 

  45. Hodder RV, Rivington RN, Calcutt LE, Hart IR. The effectiveness of immediate feedback during the objective structured clinical examination. J Med Educ. 1989;23:184–8.

    CAS  Google Scholar 

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Authors and Affiliations

  1. Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

    Sharon J. Parish MD, Melissa R. Stein MD & Julia H. Arnsten MD, MPH

  2. Division of Substance Abuse, Department of Psychiatry & Behavioral Sciences, Albert Einstein College of Medicine and Monteflore Medical Center, Bronx, NY, USA

    Megha Ramaswamy MPH, Melissa R. Stein MD & Julia H. Arnsten MD, MPH

  3. Medical Education Development, New York, NY, USA

    Elizabeth K. Kachur PhD

  4. Department of Epidemiology & Population Health, Albert Einstein College of Medicine and Montefiore Medical Center, Bronx, NY, USA

    Julia H. Arnsten MD, MPH

Authors
  1. Sharon J. Parish MD
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  2. Megha Ramaswamy MPH
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  3. Melissa R. Stein MD
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  4. Elizabeth K. Kachur PhD
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  5. Julia H. Arnsten MD, MPH
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The authors have no conflicts of interest to declare.

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Parish, S.J., Ramaswamy, M., Stein, M.R. et al. Teaching about substance abuse with objective structured clinical exams. J GEN INTERN MED 21, 453–459 (2006). https://doi.org/10.1111/j.1525-1497.2006.00426.x

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  • DOI: https://doi.org/10.1111/j.1525-1497.2006.00426.x

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