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Standardized Patient Based Curriculum for Teaching and Assessing SBIRT Curriculum ® Michelle V. Conde, MD1,2, Patricia Wathen, MD2, Audrey H. Ortega, BS2, Janet F. Williams, MD2 Audie L. Murphy VA1 and The University of Texas Health Science Center at San Antonio2 Background Information on SPs • Physicians –in- training are rarely observed directly interacting with patients. • Standardized Patients (SPs) are trained ‘actors’ who play the role of patients, families, or other members of the health care team. • Studies show SPs can realistically portray patients, and their feedback is considered valuable to learners. • SPs can be used for: • 1) formative and summative feedback for learners; • 2) curriculum assessment; • 3) research. • Advantages of using SPs are manifold: • It allows direct observation of pre-determined skills and scenarios. • “Challenging” and uncommon scenarios can be selected. Immediate verbal feedback can be delivered. • An assessment tool can be completed by the SP. Scenarios can be videotaped for review and feedback at a later date as well. UTHSCSA Experience (II): SPs for Teaching • We incorporated SPs into our medical interviewing curriculum to provide an opportunity to practice and improve skills. • The course is given to Internal Medicine PGY-1s and MSIIIs. • Topics in medical interviewing include: • Smoking Cessation • Screening and Counseling for Alcohol Abuse • Setting the Medical Agenda • The Non- adherent Patient • SPs complete checklists identifying communication skills. • Immediate individualized feedback is delivered by the SP. • The learners are also provided with written SP feedback. • Videotapes are reviewed with a faculty in small group setting. 1. 2. 3. 4. 5. UTHSCSA Experience (I): SPs for Baseline Assessment • We incorporated SP scenarios in our Objective Structured Clinical Evaluation (OSCE), which is administered in the PGY2 Fall semester. This provides both summative evaluation for the learners and also curriculum assessment. • The “Alcohol Screening Station” featured an elderly patient with insomnia. Residents were asked to take a history and identify contributing factors to his insomnia. • 71% of residents screened for depression but only 38% assessed alcohol use. • We identified that our learners did not adequately assess alcohol use, especially in presence of comorbidities. 2010 Alcohol SBIRT OSCE Station Results 2010 Alcohol SBIRT OSCE Station Results 1. 2. 3. Did the resident ask if the patient drinks alcoholic beverages? (N= 25) • Yes (88%) • No (12%) Did the resident ask how many times the patients has had ≥ 5 drinks/day (male) or ≥ 4 drinks/day (female) • Yes (68%) • No (32%) Did the resident query about drinks/week? • Yes (36%) • No (60%) • Partial (4%) Did the resident relate the drinking to the patient’s concerns and medical findings? (N= 25) • Yes (60%) • No (24%) • Partial (16%) Did the resident identify how drinking will be tracked? • Yes (8%) • No (68%) • Partial (24%) Did the resident discuss how the patient will manage highrisk situations? • Yes (4%) • No (92%) • Partial (4%) Did the resident discuss who might be willing to help, such as spouse or non- drinking friend? • Yes (12%) • No (80%) • Partial (8%) Did the resident arrange followup? • Yes (52%) • No (28%) • Partial (20%) Observations/Conclusions 1. Residents use the “one question” effectively but were less likely to ask about weekly intake. 2. Most residents were able to relate the patient’s drinking to his medical condition. 3. Residents still had significant deficits in specific skills, such as tracking alcohol use, identifying triggers, and discussing high risk situations. 4. Results reinforce need for repetitive practice of these skills. 5. New Medicare Wellness Clinic offers opportunity for additional practice under close supervision.