title: Teaching about Substance Abuse with Objective Structured Clinical Exams.
abstract: 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.
  
  
  METHODS
  Five-station OSCE, including different substance abuse disorders and readiness to change stages, administered during postgraduate year-3 ambulatory rotations for 2 years.
  
  
  METHODS
  One hundred and thirty-one internal and family medicine residents.
  
  
  METHODS
  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.
authors.affiliation: Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, NY, USA. sparish@montefiore.org
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.forename: Megha
authors.initials: M
authors.lastname: Ramaswamy
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Stein
authors.forename: Elizabeth K
authors.initials: EK
authors.lastname: Kachur
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
mesh_terms: D002983:Clinical Competence; D004521:Educational Measurement / Q000379:methods*; D005194:Family Practice / Q000193:education; D006801:Humans; D007388:Internal Medicine / Q000193:education; D007396:Internship and Residency / Q000379:methods*; D008487:Medical History Taking; D010808:Physical Examination; D010817:Physician-Patient Relations; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000628:therapy; D013663:Teaching / Q000379:methods*