Introduction

Successful communication strategies have been shown to enhance patients' satisfaction with their care^1,2 and compliance with treatment programs.^3–5 However, studies have shown that postgraduate year (PGY) 1 residents in multiple disciplines are not skilled in many aspects of adolescent communication.^6–9 Health care professions trainees also feel that their adolescents' communication training needs are not addressed in medical education, expressing interest in more training throughout the medical curriculum.¹⁰

Communication training using adolescent standardized patients (SPs) has been shown to be effective at the undergraduate level,^11,12 yet little is known about the sustained impact effectiveness of this type of training into residency. There is some evidence supporting the sustained effect of adult communication skills training from undergraduate medical education (UME) into graduate medical education.¹³ Our study aimed to determine whether structured SP adolescent interviewing with feedback in UME has a sustained effect on PGY-1 residents' adolescent interview performance.

Methods

We conducted a 2-group comparison study. PGY-1s entering Dalhousie University in Halifax, Canada, were invited to participate and were recruited from all specialties at orientation sessions prior to the start of their residency. Five female adolescent and mother pairs were trained using scripts containing sensitive adolescent topics and were encouraged to give feedback. SP pairs were randomized to each individual PGY-1 who participated. SP adolescents portrayed a 14-year-old girl.

Results

A total of 52 PGY-1s participated (34 women) of a possible 108 (48% response rate); and 23 of these had received adolescent structured training during their UME, including 1 or more adolescent SP encounters with feedback (table 1).

table 1 Demographic Information for PGY-1s With No Previous Structured Training in Undergraduate Medical Education Versus PGY-1s With Structured Training^a

Abbreviation: PGY, postgraduate year.

^a

No statistically significant difference was found between the “no structured training” group and the “structured training” group when comparing the percentage of men and women in each group or the mean age of participants. No statistically significant difference was found between the average age of the no structured training group versus the structured training group.

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The structured training group demonstrated significantly greater Total-Item and Global SCAG scores (from both SP adolescents and mothers) than the No structured training group (table 2). Cohen's d analysis demonstrated SP adolescent Total-Item and Global score effect sizes of 0.96 and 0.95, respectively. For the SP mothers, the Cohen's d effect size for the Total-Item and Global scores was 0.75 and 0.61, respectively.

table 2 Scores for PGY-1s With No Previous Structured Training in Undergraduate Medical Education Versus PGY-1s With Structured Training^a

Abbreviations: PGY, postgraduate year; SP, standardized patient.

^a

Structured training is interviewing 1 or 2 adolescent SPs with feedback. Total-Item score is the total sum of checklist item scores (maximum 58 points). Global score is total Global score (maximum 40 points).

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The online supplemental material compares the percentage of PGY-1s who received a 2 of 2 (“did well”) from adolescent SPs in all areas of interviewing between the structured training and no structured training groups.

Discussion

Our study aimed to determine whether structured adolescent training, consisting of interviews and structured feedback from an adolescent–mother SP pair in UME, had a sustained effect on PGY-1 adolescent interviewing performance.

PGY-1s who had received structured adolescent training in UME scored significantly higher on mean Total-Item and total Global SCAG scores than PGY-1s who had not. This lends support to our hypothesis that the skills acquired in interviewing an adolescent with SP feedback in UME were sustained into postgraduate training. Financial and time limitations are often cited as reasons for lack of adolescent training interventions.¹⁷ This study showed that even with limited adolescent SP encounters with structured feedback, sustained improvement in adolescent interviewing performance appears possible.

The online supplemental material compares the percentage of PGY-1s in each group who scored 2 of 2 (“did well”) from SP adolescents on each checklist item of the SCAG. There is room for improvement in many of the risk-taking areas, as well as in discussing confidentiality and separating the adolescent from the parent. This suggests the importance of training medical students, residents, and physicians in effectively facilitating good communication, separation from the adult, discussing confidentiality, and addressing risk-taking behaviors.

Limitations include a small sample size with respondents from a single institution. A second limitation is that the study utilized exclusively female SP adolescents and mothers to maintain consistency and reduce variability. A final limitation may be that our measures were based on just 1 adolescent interview for each participating resident. We believe that the SCAG's measure, which has shown both high reliability and evidence of validity in other studies,^14,15 provides an accurate assessment of PGY-1s' performance on this single occasion.

Conclusion

Structured adolescent training with feedback in adolescent interviewing could be beneficial in undergraduate medical curricula prior to learners approaching adolescents in residency training. The majority of PGY-1s will encounter adolescents and young adults, regardless of subspecialty. The importance of adolescent communication skills is not specific to pediatrics; therefore, we suggest that incorporation of these skills into postgraduate medical training would provide additional preparation for future adolescent clinical encounters.