A clinical performance exercise for medicine-pediatrics residents emphasizing complex psychosocial skills

Purpose. To assess the skills of internal medicine-pediatrics (med-peds) re sidents in evaluating and counseling patients with complex psychosocial pro blems using a clinical performance exercise (CPE). Method. The authors designed a 13-station CPE [nine standardized-patient (S P) stations and four non-SP stations]. Eight of the SP stations focused on counseling or assessing complex psychosocial needs, and three were videotap ed and analyzed for specific verbal and nonverbal communication skills. Res idents completed a written task for each station and SI's completed a check list on interviewing and communication skills and a 52-item patient's-satis faction survey. All first, and third,year residents (n=25) from two academi c years participated. Results. The range of the average scores on the nine SP stations was 43-75% . The residents performed better with common problems (newborn hospital dis charge instructions and cardiac risk-factor counseling) than with more comp lex problems that are less often encountered in the institution (HIV counse ling), or problems less often recognized (adult survivor of childhood sexua l abuse). As expected, third-year residents scored better than did first-ye ar residents on the written "plan" part of the SP stations and on the non-S P stations. Third-year and first-year residents had similar scores, however , on measures of verbal and nonverbal communication and patient's satisfact ion, and for gathering data and providing information. Conclusion. This is the first performance-based evaluation of residents in a combined med-peds residency program. The stations addressed more complex clinical skills than those reported for objective structured clinical evalu ations of residents.