Didactic lecture versus instructional standardized patient interaction in the surgical clerkship

• Published in: The American journal of surgery Vol. 189; no. 2; pp. 243 - 248
• Main Authors: Carter, Mary B., Wesley, Gina, Larson, Gerald M.
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.02.2005; Elsevier; Elsevier Limited
• Subjects: Acute appendicitis; Adult; Appendicitis; Biological and medical sciences; Colleges & universities; Confidence; Curricula; Curriculum; Didacticism; Education; Education, Medical, Undergraduate; Feedback; General aspects; General Surgery - education; Humans; Junior surgery clerkship; Likert scale; Medical sciences; Medical students; National Board of Medical Examiners Surgery Subject Exam; Patient Education as Topic; Patient Simulation; Patients; Physical Examination; Physician-Patient Relations; Professional Competence; Randomized, prospective trial; Self-confidence; Simulated patient; Skills; Standardized patient; Standardized patient interaction; Student attitudes; Student enjoyment; Student perception; Student preference; Student satisfaction; Students, Medical; Surgery; Teachers; Teaching; Undergraduate medical education; USMLEStep 2 CS; Randomized, prospective trial; Student enjoyment; Student preference; Standardized patient interaction; National Board of Medical Examiners Surgery Subject Exam; Junior surgery clerkship; USMLEStep 2 CS; Acute appendicitis; Simulated patient; Confidence; Self-confidence; Student satisfaction; Undergraduate medical education; Standardized patient; Student perception; Human; Medicine; prospective trial; Treatment; Surgery; Interaction; Undergraduate medical education; Junior surgery clerkship; Standardized patient; Standardized patient interaction; USMLEStep 2 CS; Acute appendicitis; National Board of Medical Examiners Surgery Subject Exam; Simulated patient; Student perception; Student satisfaction; Student enjoyment; Student preference; Confidence; Self-confidence; Randomized; Comparative study
• ISSN: 0002-9610; 1879-1883
• DOI: 10.1016/j.amjsurg.2004.09.013

Medical schools increasingly employ the standardized patient interaction (SPI) as a teaching and testing modality to prepare students for USMLE Step 2 Clinical Skills (Step 2 CS). However, little is known about the perceptions medical students have toward SPIs. We hypothesized that the SPI would increase the self-confidence of surgery students in their history and physical examination (H&P) skills as compared with the classic lecture format and that students would perceive the SPI as a valuable learning tool. Students (n = 126) on the junior surgery clerkship were randomized into two groups. Group A (n = 61) received a didactic lecture on acute appendicitis. Group B (n = 65) participated in an SPI in which the portrayed patient had acute appendicitis. Student perceptions were surveyed by written questionnaire pre- and postencounter using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the SPI, clerkship grades) were compared using a Student t test followed by the Mann-Whitney rank sums test. Group A “enjoyed” the lecture format more than group B “enjoyed” the SPI format (3.4 ± 0.1 versus 2.6 ± 0.1, P <.001) and perceived the lecture as having more value to their overall education (3.5 ± 0.1 versus 2.6 ± 0.1, P <.001) than the SPI group. Surprisingly, student self-confidence in their H&P skills increased after the didactic lecture (from 3.6 ± 0.1 to 4.1 ± 0.1, P = .001) but not after the SPI (from 3.6 ± 0.1 to 3.8 ± 0.1, P = not significant). The didactic lecture format was not only enjoyed and valued more than the SPI, but our surgery students also perceived it as superior to the SPI in building confidence in history and physical examination skills. These findings suggest that surgical educators should develop ways to improve students’ perceptions and attitudes surrounding the surgical SPI.