Medical Students' Self-Reported Typical Counseling Practices Are Similar to Those Assessed With Standardized Patients

E. Frank, MD, MPH; L. McLendon, MPH; M. Denniston, MSPH; D. Fitzmaurice, BS; V. Hertzberg, PhD; L. Elon, MS, MPH

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Abstract and Introduction

Context/Objectives: We surveyed fourth-year medical students in the Class of 2003 at Emory University School of Medicine, Atlanta, Georgia, about various personal and clinical practices. We were especially interested in the frequency that these seniors reported of talking with patients about nutrition, weight, exercise, alcohol, and cigarette smoking. Because the validity of our findings about these counseling practices was limited by our having only self-reported data from seniors' questionnaires, we developed a standardized patient (SP) examination to test the relationship between what students reported on the questionnaires and how they actually performed with SPs.
Design/Setting/Main Outcome Measures: As part of a lengthy questionnaire, 88 senior medical students answered these 5 separated questions: "With a typical general medicine patient, how often do you actually talk to patients about: (1) nutrition; (2) exercise/physical activity; (3) weight; (4) smoking cessation (among smokers); and (5) alcohol? (never/rarely, sometimes, usually/always)." As part of their internal medicine subinternship final exam, students clinically assessed 4 SP cases with predetermined risk factors (poor diet, exercise, alcohol, and/or cigarette-smoking habits).
Results: For every risk factor, the proportion of SPs actually counseled was higher for those students who self-reported discussing that risk factor more frequently with their patients. Additionally, the odds of counseling an SP for any risk factor were significantly higher (odds ratio = 1.76-2.80, P < .05) when students reported more frequent counseling.
Conclusion: Student self-reports regarding patient counseling may be useful when resources are limited, and the purpose is to grossly and anonymously distinguish between higher and lower performers.

We surveyed Emory University School of Medicine (Atlanta, Georgia) medical students in the Class of 2003 on 3 occasions (first-year orientation, entry to wards, and senior year). Among many questionnaire items about students' personal and clinical practices, we were especially interested in the frequency that they reported as seniors of talking to patients about nutrition, exercise, alcohol, and cigarette smoking. However, the validity of our findings about these counseling practices was limited by the self-reported nature of these data.

Prior publications on the relationship between students' self-report and their actual performance with standardized patients (SPs) are limited. The few prior studies that have been conducted correlating physicians'/medical students' self-reports and their clinical performance have been generally (although not strongly) positive, finding that clinician underreporting[1,2] of performance may be more common than overreporting.[3] Given the limitations of previous studies, we developed an SP program to test the relationship between what students reported on the questionnaires and what they actually did with SPs.

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