Teaching and Assessing Residents’ Skills in Managing Heroin Addiction With Objective Structured Clinical Examinations (OSCEs)

ABSTRACT

Background: Heroin-abusing patients present a significant challenge. Objective Structured Clinical Examinations (OSCEs) allow evaluation of residents’ clinical skills. The objective of this study was to examine residents’ OSCE performance assessing and managing heroin abuse. Methods: Evaluation and comparison of heroin-specific communication, assessment, and management skills in a 5-station postgraduate year 3 (PGY3) substance abuse OSCE. Faculty used a 4-point Likert scale to assess residents’ skills; standardized patients provided written comments. Results: Two hundred sixty-five internal and family medicine residents in an urban university hospital participated over 5 years. In the heroin station, residents’ skills were better (P < .001 for both comparisons) in communication (mean overall score: 316 ± 0.51) than in either assessment (mean overall score: 2.66 ± 0.60) or management (mean overall score: 2.50 ± 0.73). The mean score for assessing specific high-risk behaviors was lower than the mean overall assessment score (222 ± 1.01 vs. 2.74 ± .59; P < .0001), and the mean score for recommending appropriate harm reduction management strategies was lower than the mean overall management score (2.39 ± .89 vs. 2.54 ± .74; P < .005). Standardized patients’ comments reflected similar weaknessess in residents’ skills. Conclusions: Assessment and management of heroin abuse were more challenging for residents than general communication. Additional training is required for residents to assess and counsel patients about high-risk behaviors.

Keywords:

• Heroin addiction
• Objective Structured Clinical Examination (OSCE)
• substance abuse

Acknowledgments

Portions of this research were presented at the Society of General Internal Medicine Mid-Atlantic Regional Meeting in March 2007, the Society of General Internal Medicine 30th Annual Meeting in May 2007, and the Meeting of the Association of Medical Education and Research in Substance Abuse in November 2007.

The project was supported by NIH R25 DA 14551 and R25 DA023021 (to J. Arnsten).