Medical students' attention to multiple risk behaviors: a standardized patient examination.
BACKGROUND
Risk behaviors tend to cluster, particularly among smokers, with negative health effects. To optimize patients' health and wellbeing, health care providers ideally would assess and intervene upon the multiple risks with which patients may present.


OBJECTIVE
This study examined medical students' skills in assessing and treating multiple risk behaviors.


METHODS
Using a randomized experimental design, medical students' counseling interactions were evaluated with a standardized patient presenting with sexual health concerns and current tobacco use with varied problematic drinking status (alcohol-positive or alcohol-negative).


METHODS
One hundred and fifty-six third-year medical students.


METHODS
Student and standardized patient completed measures evaluated student knowledge, attitudes, and clinical performance.


RESULTS
Overall, most students assessed tobacco use (85%); fewer assessed alcohol use (54%). Relative to the alcohol-negative case, students seeing the alcohol-positive case were less likely to assess sexually transmitted disease history (80% vs. 91%, p = 0.042), or patients' readiness to quit smoking (41% vs. 60%, p = 0.025), and endorsed greater attitudinal barriers to tobacco treatment (p = 0.030). Patient satisfaction was significantly lower for the alcohol-positive than the alcohol-negative case; clinical performance ratings moderated this relationship.


CONCLUSIONS
When presented with a case of multiple risks, medical students performed less effectively and received lower patient satisfaction ratings. Findings were moderated by students' overall clinical performance. Paradigm shifts are needed in medical education that emphasize assessment of multiple risks, new models of conceptualizing behavior change as a generalized process, and treatment of the whole patient for optimizing health outcomes.
Department of Psychiatry, University of California, 401 Parnassus Ave-TRC 0984, San Francisco, CA, USA. JProchaska@ucsf.edu
Judith J
JJ
Prochaska
Kathleen
K
Gali
Bernie
B
Miller
Karen E
KE
Hauer
D000437:Alcoholism / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D002140:California; D002982:Clinical Clerkship / Q000592:standards; D002983:Clinical Competence; D003376:Counseling / Q000592:standards; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000379:methods / Q000592:standards*; D006801:Humans; D008487:Medical History Taking / Q000592:standards*; D017060:Patient Satisfaction; D016544:Patient Simulation; D010817:Physician-Patient Relations; D011897:Random Allocation; D012309:Risk-Taking; D012749:Sexually Transmitted Diseases / Q000175:diagnosis / Q000523:psychology; D012907:Smoking / Q000523:psychology; D016540:Smoking Cessation; D000074606:Smoking Prevention; D013337:Students, Medical / Q000523:psychology*