Original StudyMedical Students' Acquisition of Adolescent Interview Skills after Coached Role Play
Introduction
Adolescents, who constitute 13% of the population in the United States, have specific health care needs, and addressing their needs requires skillful communication. Although pediatric residents must complete a rotation in adolescent medicine, other residents receive inconsistent training, although most family physicians, surgeons, obstetricians/gynecologists, and internal medicine physicians as well as many subspecialists care for adolescents in their practices.1, 2 National organizations have called for increased preparation for health care providers to better work with adolescents. The Institute of Medicine report on adolescent health services noted that existing adolescent health care training across health care provider disciplines fails to address adolescents’ specific health needs.3 Professional organizations, including the North American Society for Pediatric and Adolescent Gynecology (NASPAG), American Academy of Pediatrics, Physicians for Reproductive Health, American Nurses Association, and the Society for Adolescent Health and Medicine, have recognized the unique needs of adolescents and have advocated for more training in this area.4, 5, 6, 7, 8, 9
Although pediatric residencies require an adolescent medicine rotation, even with this residency training, practicing pediatricians believe they are less competent to care for adolescents than for infants or children.2 Because residents in other specialties receive inconsistent adolescent medicine training, their training as medical students has greater importance. Most studies have focused on resident training in adolescent medicine, although the 2008 William T. Grant Foundation Conference on Improving Adolescent and Young Adult Health recommended incorporating more teaching and mentoring in adolescent health education for medical students.10, 11, 12, 13 Few data exist, however on medical student education in adolescent medicine. The amount and content of instruction about adolescent care currently offered to medical students nationally is unknown. A few articles describe using adolescent standardized patients for instructional or assessment purposes.14, 15 In our previous study using an adolescent objective structured clinical examination case the focus was to conduct an interview with an adolescent coming in to initiate contraceptive care.16
In response to the needs for education about pediatric and adolescent gynecology (PAG), NASPAG4 developed the Short and Long Curriculum.17, 18 An evaluation study of the short curriculum showed improved self-reported knowledge in PAG after residents used the NASPAG Short Curriculum to guide self-study, even without access to PAG-trained faculty.19 However, we still need specific approaches to teach the needed skills and clear evidence of skill development after specific educational interventions. As noted in the Short as well as Long Curriculum, skills for communicating with adolescents are a critical component of basic education in PAG.17, 18 One specific and practical way to equip medical students, residents, and others who provide care for adolescents with the skills needed to communicate with this population is to teach them to do a Home, Education and employment, Eating, Activities, Drugs, Sexuality, Suicide/depression, and Safety (HEADS) interview. The HEADS interview is recognized as a useful approach to communication with adolescents and is also part of the NASPAG Short as well as Long Curriculum.17, 18
The HEADS framework provides an organized approach to adolescent interviewing that starts with nonthreatening topics like home and school and progresses to more personal questions regarding substance abuse, depression, and sexuality to assist the adolescent in being more comfortable in communicating with the health care provider. The HEADS approach to adolescent interviews was developed in 1972 by H. Berman in Seattle and refined and taught by E. Cohen as a psychosocial risk assessment instrument.20 A HEADS interview addresses the following areas: home, education, activities, drug use, sexual behavior, and suicidality/depression. More recently, an additional E for eating and S for safety have been added in response to concerns about obesity, eating disorders, and issues regarding safety and accidents.21 In 2014, Klein et al updated the HEADS assessment to include response to the effect of the media.22 There is also evidence that the HEADS interview yields valid data when used to screen for mental disorders.23, 24
We developed a specific approach to teaching and assessing adolescent communication to medical students.25 The purpose of this study was to develop and evaluate the effectiveness of this educational activity in teaching the skills needed to do the adolescent HEADS examination.
Section snippets
Materials and Methods
The Colorado Multiple Institutional Review Board approved this study. The study participants were third-year medical students completing their pediatric clerkship. Three weeks before the educational session, students received an email with an article on the adolescent HEADS interview to read (the same article referenced in the Short and Long NASPAG Curriculum).21 They were instructed to read the article and arrive at the session prepared to write a learning goal related to performing a HEADS
Results
One hundred fifty-two medical students participated in the teaching session about the adolescent interview and the subsequent SPE across 8 rotations of the third-year pediatric clerkship; 133 of these students completed the retrospective pre-/post-questionnaire (this questionnaire was not offered to the 19 students in the first rotation of the academic year). Figure 1 shows the percentage of students who asked at least 1 question in each of the key topic areas of the HEADS exam (90% home; 91%
Discussion
After an introduction to the HEADS examination, most students covered almost all of the key topic areas of this screening interview during a SPE, although only 61% of the students included questions about symptoms of depression. This study provides evidence that coached role play with goal-setting is an effective way to teach this approach to adolescent interviewing, although the teaching might need additional emphasis on questions about depression.
The study shows that the educational session
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The authors indicate no conflicts of interest.