The authors have no conflicts of interest to declare.Portions of this research were presented at the Society of General Internal Medicine Mid-Atlantic Regional Meeting in March 2004, the Society of General Internal Medicine 27th Annual Meeting in May 2004, and the meeting of the Association of Medical Education and Research in Substance Abuse in November 2004. The project was supported by NIH R25 DA 14551 to Montefiore Medical Center (P.I. J. Arnsten).
Teaching About Substance Abuse with Objective Structured Clinical Exams
Article first published online: 25 APR 2006
Journal of General Internal Medicine
Volume 21, Issue 5, pages 453–459, May 2006
How to Cite
Parish, S. J., Ramaswamy, M., Stein, M. R., Kachur, E. K. and Arnsten, J. H. (2006), Teaching About Substance Abuse with Objective Structured Clinical Exams. Journal of General Internal Medicine, 21: 453–459. doi: 10.1111/j.1525-1497.2006.00426.x
- Issue published online: 25 APR 2006
- Article first published online: 25 APR 2006
- substance abuse;
- alcoholism and addictive behaviors;
- objective structured clinical exam (OSCE);
- standardized patients;
- residency evaluation
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.