Using Standardized Patients to Identify Students Needing Extra Training in Interviewing Skills

Objective: To identify students who need extra help with interviewing skills before they begin clerkship. Description: Students beginning the third year in the MD program at Dalhousie University (n = 96) complete the one-month Introduction to Clerkship (ITC) course as part of their preparation for clerkship. In the second year patient—doctor unit, we identified two interviewing tasks that students found difficult: interviewing the toddler and the adolescent. The aim of the pediatrics component of the ITC course is to provide students with basic skills in these areas, thereby giving them the confidence to enter the clerkship and practice to enhance their skills. The students attended two separate one-hour didactic sessions on interviewing people in these age groups. (Most students will have completed five pediatric patient—doctor sessions in second year, where these skills were introduced). Following the didactic sessions the students were assigned to one of six groups of 16–18 led by a faculty member. The groups then interviewed an adolescent—mother standardized-patient pair (SPs) and the next day a toddler (<4 years old) and mother using a simulated scenario. In the adolescent encounter, the students were instructed to take turns in interviewing the SPs, using “time out” and repeating difficult aspects of the encounter, e.g., the separation of the adolescent from the parent, the discussion of confidentiality. The faculty preceptor gave intermittent feedback, while the SPs gave feedback at the end of the session.1 The group process took two hours, with the students about having about five minutes of total interviewing time. The process was repeated with the toddler—mother session. The faculty members individually identified the students who lacked confidence in the adolescent interview and/or the toddler interaction. Their judgments were confirmed by the SPs. The students identified as needing extra help (n = 12) are now being offered two structured sessions with the SP pairs. This will be in format similar to the ITC, except that the students will complete all the interviewing alone. The interviews will be videotaped and feedback will be offered by the SPs. The videos will be critiqued (by KB), with constructive feedback to the students. All students will complete an OSCE six or 12 months into their clerkship; The OSCE will include components of the adolescent and toddler interviews. Discussion: The SP/faculty identification of students needing extra instruction in key areas of pediatric interviewing will be used as a screening tool. The process is inexpensive compared with students' failing an OSCE and needing remediation (which is common enough to warrant identification—12/92) and provides an intervention to help students attain a satisfactory level of competence. The screening method will be evaluated as to its predictive value, and the remediated students' level of achievement will be assessed at the OSCE and compared with that of their class. This method of identifying a subgroup of students who may be at risk of low achievement could be reproducible in other areas of medicine.