title: Teaching and assessing residents' skills in managing heroin addiction with objective structured clinical examinations (OSCEs).
abstract: BACKGROUND
  Heroin-abusing patients present a significant challenge. Objective Structured Clinical Examinations (OSCEs) allow evaluation of residents' clinical skills. The objective of this study was to examine residents' OSCE performance assessing and managing heroin abuse.
  
  
  METHODS
  Evaluation and comparison of heroin-specific communication, assessment, and management skills in a 5-station postgraduate year 3 (PGY3) substance abuse OSCE. Faculty used a 4-point Likert scale to assess residents' skills; standardized patients provided written comments.
  
  
  RESULTS
  Two hundred sixty-five internal and family medicine residents in an urban university hospital participated over 5 years. In the heroin station, residents' skills were better (P < .001 for both comparisons) in communication (mean overall score: 316 ± 0.51) than in either assessment (mean overall score: 2.66 ± 0.60) or management (mean overall score: 2.50 ± 0.73). The mean score for assessing specific high-risk behaviors was lower than the mean overall assessment score (222 ± 1.01 vs. 2.74 ± .59; P < .0001), and the mean score for recommending appropriate harm reduction management strategies was lower than the mean overall management score (2.39 ± .89 vs. 2.54 ± .74; P < .005). Standardized patients' comments reflected similar weaknessess in residents' skills.
  
  
  CONCLUSIONS
  Assessment and management of heroin abuse were more challenging for residents than general communication. Additional training is required for residents to assess and counsel patients about high-risk behaviors.
authors.affiliation: a Division of General Internal Medicine, Department of Medicine , Albert Einstein College of Medicine and Montefiore Medical Center , Bronx , New York , USA.
authors.forename: Sharon J
authors.initials: SJ
authors.lastname: Parish
authors.forename: Melissa R
authors.initials: MR
authors.lastname: Stein
authors.forename: Steven R
authors.initials: SR
authors.lastname: Hahn
authors.forename: Uri
authors.initials: U
authors.lastname: Goldberg
authors.forename: Julia H
authors.initials: JH
authors.lastname: Arnsten
mesh_terms: D002983:Clinical Competence; D004503:Education, Medical, Graduate; D005194:Family Practice / Q000193:education*; D006556:Heroin Dependence / Q000628:therapy*; D006801:Humans; D007388:Internal Medicine / Q000193:education*; D007396:Internship and Residency