title: Using standardized patient encounters to teach longitudinal continuity of care in a family medicine clerkship.
abstract: BACKGROUND
  Despite demonstrated benefits of continuity of care, longitudinal care experiences are difficult to provide to medical students. A series of standardized patient encounters was developed as an innovative curricular element to address this gap in training for medical students in a family medicine clerkship. The objective of this paper is to describe the development and implementation of the curriculum, evaluate the effectiveness of the curriculum for increasing student confidence around continuity of care and chronic disease management, and explore student opinions of the value of the experience.
  
  
  METHODS
  The encounters simulate continuity of care in typical family medicine practice over four standardized patient visits, providing students with experience in longitudinal relationships, ongoing management of chronic and acute conditions, lifestyle counseling, and the use of an electronic medical record. Perceptions of the curriculum were obtained using a pre-post survey asking students to self-rate experience and confidence in continuity relationships, chronic disease management, and lifestyle counseling. Students were also asked about the overall effectiveness of the encounters for simulating family practice and continuity of care. Open-ended comments were gathered through weekly reflection papers submitted by the students.
  
  
  RESULTS
  Of 138 third-year medical students, 137 completed the pre-survey, 126 completed the post-survey, and 125 (91%) completed both the pre- and the post-survey. Evaluation results demonstrated that students highly valued the experience. Complete confidence data for 116 students demonstrated increased confidence pre-post (t(115) = 14.92, p < .001) in managing chronic disease and establishing relationships. Open-ended comments reflected how the experience fostered appreciation for the significance of patient-doctor relationships and continuity of care.
  
  
  CONCLUSIONS
  This curriculum offers a promising approach to providing students with continuity of care experience. The model addresses a general lack of training in continuity of care in medical schools and provides a standardized method for teaching chronic disease management and continuity relationships.
authors.affiliation: Department of Family Medicine, University at Buffalo, 77 Goodell Street, Suite 220, Buffalo, NY, 14203, USA.
authors.forename: Bonnie M
authors.initials: BM
authors.lastname: Vest
authors.affiliation: Department of Anthropology, University at Buffalo, 380 MFAC, Buffalo, NY, 14228, USA.
authors.forename: Abigail
authors.initials: A
authors.lastname: Lynch
authors.affiliation: Department of Family Medicine, University at Buffalo, 202 Farber Hall, Buffalo, NY, 14214, USA.
authors.forename: Denise
authors.initials: D
authors.lastname: McGuigan
authors.affiliation: Department of Psychology, Canisius College, 2001 Main Street, Buffalo, NY, 14208, USA.
authors.forename: Timothy
authors.initials: T
authors.lastname: Servoss
authors.affiliation: Clinical Competency Center, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, 211 Cary Hall, Buffalo, NY, 14214, USA.
authors.forename: Karen
authors.initials: K
authors.lastname: Zinnerstrom
authors.affiliation: Department of Family Medicine, University at Buffalo, 202 Farber Hall, Buffalo, NY, 14214, USA. symons@buffalo.edu.
authors.forename: Andrew B
authors.initials: AB
authors.lastname: Symons
mesh_terms: D002982:Clinical Clerkship / Q000379:methods*; D003266:Continuity of Patient Care / Q000592:standards*; D003479:Curriculum; D005194:Family Practice / Q000193:education* / Q000592:standards; D006801:Humans; D008137:Longitudinal Studies; D009862:Online Systems; D010817:Physician-Patient Relations; D010865:Pilot Projects; D015397:Program Evaluation; D013337:Students, Medical; D011795:Surveys and Questionnaires
keywords: Continuity of care; Family medicine; Medical education; Standardized patient encounters