title: An educational intervention for contextualizing patient care and medical students' abilities to probe for contextual issues in simulated patients.
abstract: BACKGROUND
  A contextual error occurs when a physician does not identify elements of a patient's environment or behavior, such as access to care, that must be addressed to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients.
  
  
  OBJECTIVE
  To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors.
  
  
  METHODS
  Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n = 124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010 participated and were assessed.
  
  
  METHODS
  A 4-hour course on contextualization.
  
  
  METHODS
  Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant and were adjusted for subinternship site, academic year, time of year, and case scenario.
  
  
  RESULTS
  Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87%-94% ] vs 62% [95% CI, 54%-69%], respectively) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57%-81%] vs 22% [95% CI, 12%-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75%-85%] vs 81% [95% CI, 76%-86%]) or developing appropriate treatment plans for standardized patients with medical issues (54% [95% CI, 42%-67%] vs 66% [95% CI, 53%-79%]).
  
  
  CONCLUSIONS
  Medical students who underwent an educational intervention were more likely to contextualize care for individual standardized patients.
authors.affiliation: Department of Medical Education, University of Illinois at Chicago, Chicago, Illinois, USA. alansz@uic.edu
authors.forename: Alan
authors.initials: A
authors.lastname: Schwartz
authors.forename: Saul J
authors.initials: SJ
authors.lastname: Weiner
authors.forename: Ilene B
authors.initials: IB
authors.lastname: Harris
authors.forename: Amy
authors.initials: A
authors.lastname: Binns-Calvey
mesh_terms: D000328:Adult; D004501:Education, Medical / Q000379:methods; D004777:Environment; D005260:Female; D015438:Health Behavior; D006297:Health Services Accessibility; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D008297:Male; D008487:Medical History Taking / Q000379:methods*; D010347:Patient Care Planning; D016544:Patient Simulation; D010817:Physician-Patient Relations; D013337:Students, Medical; D055815:Young Adult