BackgroundAlthough options counseling is a fundamental skill for medical providers, previous research has identified gaps in medical school reproductive health education.PurposeTo determine if a 1-h novel patient interaction (NPI) improves student performance when caring for a standardized patient with an unintended pregnancy.MethodsFrom September 2012 to June 2013 we randomized third-year medical students at the University of Colorado School of Medicine to the standard curriculum plus an NPI, or the standard curriculum only. The NPI consisted of a 1-h small-group session with a patient who discussed her experiences with options counseling and her decision to terminate her pregnancy. Students completed an Objective Structured Clinical Examination (OSCE) at the rotation's end, which included options counseling. The primary outcome was the proportion of participants achieving ‘excellence’ on the OSCE checklist. ‘Excellence’ was defined as a score ≥90%. Examinations were flagged as ‘unsatisfactory encounters’ if core competencies were not addressed. OSCE standardized patients and evaluators were blinded to group assignment.ResultsIn total, 135 students were eligible and randomized: 75 to NPI; 60 to control. During the OSCE, few students achieved ‘excellence’ (24% NPI vs. 28% control, p =0.57).There were no differences between scores for components of options counseling. More students in the control group ‘appeared somewhat uncomfortable’ delivering the pregnancy test results (5% NPI vs. 18% control, p =0.006). More than half (54%) of the intervention group and 67% of controls had ‘unsatisfactory encounters’ (p =0.16), almost exclusively due to omission of adoption. Most students addressed abortion (96% NPI vs. 92% control, p =0.29).ConclusionsA 1-h NPI does not improve medical students’ performance of pregnancy options counseling and the option of adoption is routinely omitted. Adoption is clearly an area that needs greater attention when designing comprehensive reproductive health curriculum for medical students.
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机译：背景技术尽管选择咨询是医疗服务提供者的一项基本技能，但先前的研究已经确定了医学院生殖健康教育方面的差距。目的是确定在护理意想不到的怀孕的标准化患者时进行1小时的新型患者互动（NPI）是否可以改善学生的表现。方法从2012年9月至2013年6月，我们将科罗拉多大学医学院的三年级医学生随机分配到标准课程和NPI或仅标准课程中。 NPI由与患者进行的1小时小组会议组成，该患者讨论了她在选择咨询中的经历以及她决定终止妊娠的决定。学生在轮换结束时完成了客观结构化临床考试（OSCE），其中包括选择咨询。主要结果是参与者在OSCE清单上获得“卓越”的比例。 “卓越”是指得分≥90％。如果没有解决核心能力，则考试被标记为“考试成绩不佳”。结果共有135名学生符合条件并随机分组：75名为NPI; 5名为NPI; 5名未参加OSCE标准化患者和评估者。 60来控制。在OSCE期间，很少有学生达到“卓越”水平（NPI为24％，对照为28％， p = 0.57）。选择咨询的分数没有差异。对照组的更多学生“看起来有些不舒服”，提供了妊娠试验的结果（5％NPI对比18％对照， p = 0.006）。干预组中有一半以上（54％）和对照组中有67％的经历“不令人满意”（ p = 0.16），几乎完全是由于忽略了采用。大多数学生解决了流产问题（96％的NPI与92％的对照， p = 0.29）。结论1小时的NPI不能改善医学生的妊娠选择咨询服务，通常会采用收养选择。在为医学生设计综合生殖健康课程时，领养显然是一个需要更多关注的领域。
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