title: A clinical performance exercise for medicine--pediatrics residents emphasizing complex psychosocial skills.
abstract: OBJECTIVE
  To assess the skills of internal medicine-pediatrics (med-peds) residents in evaluating and counseling patients with complex psychosocial problems using a clinical performance exercise (CPE).
  
  
  METHODS
  The authors designed a 13-station CPE [nine standardized-patient (SP) stations and four non-SP stations]. Eight of the SP stations focused on counseling or assessing complex psychosocial needs, and three were videotaped and analyzed for specific verbal and nonverbal communication skills. Residents completed a written task for each station and SPs completed a checklist on interviewing and communication skills and a 52-item patient's-satisfaction survey. All first- and third-year residents (n = 25) from two academic 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 discharge instructions and cardiac risk-factor counseling) than with more complex problems that are less often encountered in the institution (HIV counseling), or problems less often recognized (adult survivor of childhood sexual abuse). As expected, third-year residents scored better than did first-year residents on the written "plan" part of the SP stations and on the non-SP stations. Third-year and first-year residents had similar scores, however, on measures of verbal and nonverbal communication and patient's satisfaction, and for gathering data and providing information.
  
  
  CONCLUSIONS
  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 evaluations of residents.
authors.affiliation: Division of General Internal Medicine, University of Kentucky College of Medicine, Lexington 40536-0284, USA. mbduke2@uky.edu
authors.forename: M B
authors.initials: MB
authors.lastname: Duke
authors.forename: C H
authors.initials: CH
authors.lastname: Griffith
authors.forename: S A
authors.initials: SA
authors.lastname: Haist
authors.forename: J F
authors.initials: JF
authors.lastname: Wilson
mesh_terms: D002983:Clinical Competence; D003142:Communication; D003376:Counseling; D004521:Educational Measurement / Q000379:methods; D004650:Employee Performance Appraisal / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D017060:Patient Satisfaction; D010372:Pediatrics; D012944:Social Support