Teaching and assessing residents skills in managing heroin addiction with objective structured clinical examinations (OSCEs)

Sharon J. Parish, Melissa R. Stein, Steven R. Hahn, Uri Goldberg, Julia H. Arnsten

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)350-355
Number of pages6
JournalSubstance Abuse
Issue number4
StatePublished - Oct 1 2013


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

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Psychiatry and Mental health


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