title: The effectiveness of using standardized patients to improve community physician skills in mammography counseling and clinical breast exam.
abstract: BACKGROUND
  Traditional didactic continuing education is relatively ineffective in improving physicians' clinical skills. We hypothesized that a centralized course including small group workshops utilizing standardized patients could improve clinical skills for a reasonable cost.
  
  
  METHODS
  We designed a 5-h course aimed at improving physicians' counseling skills (re: screening mammography) and clinical breast exam (CBE) skills. The course included lectures, demonstrations, and small group skills sessions utilizing standardized patients and was offered to 156 typical community-based primary care physicians. Pre- and postcourse evaluation included in-office assessments of physician CBE and counseling performance by standardized patients and a written test of knowledge and attitudes.
  
  
  RESULTS
  A total of 54.5% of eligible physicians participated. They improved modestly in only one of three areas of counseling skills measured (providing counseling appropriate to the patient's readiness to accept mammography, P = 0.01). The overall CBE score increased substantially from 24.8 to 34.7 (P < 0.0001). Knowledge in all areas measured and confidence in counseling patients also increased. The basic course cost $202 per physician trained.
  
  
  CONCLUSIONS
  Most community-based primary care physicians may find small group training and in-office evaluation involving standardized patients acceptable. Such training may be more effective in improving physical exam skills than complex communication skills.
authors.affiliation: University of Massachusetts Medical School, Worcester 01655, USA. Mary.Costanza@banyan.ummed.edu
authors.forename: M E
authors.initials: ME
authors.lastname: Costanza
authors.forename: R
authors.initials: R
authors.lastname: Luckmann
authors.forename: M E
authors.initials: ME
authors.lastname: Quirk
authors.forename: L
authors.initials: L
authors.lastname: Clemow
authors.forename: M J
authors.initials: MJ
authors.lastname: White
authors.forename: A M
authors.initials: AM
authors.lastname: Stoddard
mesh_terms: D001943:Breast Neoplasms / Q000175:diagnosis*; D002983:Clinical Competence / Q000592:standards*; D003376:Counseling / Q000193:education*; D004502:Education, Medical, Continuing / Q000379:methods*; D005194:Family Practice / Q000193:education*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008327:Mammography; D008403:Mass Screening / Q000379:methods; D010173:Palpation; D016544:Patient Simulation; D015397:Program Evaluation