Residents' Asthma Communication Skills in Announced Versus Unannounced Standardized Patient Exercises

Objective: The aim of this study was to test the hypothesis that pediatric residents would display similar levels of asthma interpersonal and communication skills in announced versus unannounced adolescent standardized patient (SP) encounters. Methods: We conducted a prospective repeat measures experimental study at a pediatric residency program at an inner-city children's hospital. A cohort of residents (N = 18) was subjected at random to 3 SP exercises: announced and being directly observed by faculty, announced and not observed by faculty, and unannounced and unobserved. Six adolescent SPs were trained to complete checklists that included items like asthma daytime and nighttime symptoms, exercise-induced symptoms, triggers, and asthma education. For the unannounced exercises, SPs were inserted into residents' regularly scheduled clinics. Standardized patients rated residents immediately following each exercise. Residents were rated by faculty following the observed encounter. Faculty rating validated SP ratings on the observed encounter. Differences in proportions of categorical variables were tested by chi-square analyses. Results: Fifty-four resident-SP encounters were analyzed. Residents consistently displayed significantly lower levels of desired behaviors in interpersonal and communication skills in the unannounced SP encounters on 10 of 14 checklist items. For example, residents asked about exercise-induced symptoms 90% of the time in announced/observed encounters versus 95% in announced/unobserved encounters versus 72% in unannounced/unobserved encounters (P = .001). There were no significant differences in residents' behaviors in the announced SP exercises (whether observed or unobserved). Conclusion: In this study, residents demonstrated lower levels of asthma communication skills during unannounced SP exercises. By using unannounced SPs, we were able to assess residents' interpersonal and communication skills in real clinical settings.