title: Effect of novel patient interaction on students' performance of pregnancy options counseling.
abstract: BACKGROUND
  Although options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education.
  
  
  OBJECTIVE
  To determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy.
  
  
  METHODS
  From September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving 'excellence' on the OSCE checklist. 'Excellence' was defined as a score ≥90%. Examinations were flagged as 'unsatisfactory encounters' if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment.
  
  
  RESULTS
  In total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved 'excellence' (24% NPI vs. 28% control, p=0.57).There were no differences between scores for components of options counseling. More students in the control group 'appeared somewhat uncomfortable' delivering the pregnancy test results (5% NPI vs. 18% control, p=0.006). More than half (54%) of the intervention group and 67% of controls had 'unsatisfactory encounters' (p=0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p=0.29).
  
  
  CONCLUSIONS
  A 1-h NPI does not improve medical students' performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students.
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, MD, USA.
authors.forename: Angela
authors.initials: A
authors.lastname: Shaddeau
authors.affiliation: Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Nimz
authors.affiliation: Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
authors.forename: Jeanelle
authors.initials: J
authors.lastname: Sheeder
authors.affiliation: Department of Obstetrics & Gynecology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA; kristina.tocce@ucdenver.edu.
authors.forename: Kristina
authors.initials: K
authors.lastname: Tocce
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003120:Colorado; D003142:Communication; D003376:Counseling; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010817:Physician-Patient Relations; D011247:Pregnancy; D011275:Pregnancy, Unwanted; D013337:Students, Medical; D055815:Young Adult
keywords: OSCE; abortion; options counseling