Training and Evaluating Tobacco-specific Standardized Patient Instructors

Kristie Foley

Geeta George

Sonia Crandall

Kathy Walker

Gail Marion

John Spangler

Department of Public Health Sciences (Dr Foley) and the Department of Family and Community Medicine (Drs Foley, Crandall, Marion, and Spangler, and Ms Walker), Wake Forest University; and the Physician Assistant Program, George Washington University (Ms Goerge)

Corresponding Author: Address correspondence to Dr Foley, Wake Forest University, School of Medicine, Department of Public Health Sciences, Medical Center Boulevard, Winston-Salem, NC 27157. 336-716-9881. Fax: 336-716-7554. ude.cmbufw@yelofk

Abstract

Background and Objectives

A comprehensive training program to develop tobacco-specific standardized patient instructors (SPIs) was implemented and evaluated at Wake Forest University.

Methods

Descriptive statistics were used to assess SPIs’ experience with the training program and medical students’ perceptions of the SPI-student interaction. Two standardized scales, used to assess student performance on counseling (Tobacco Intervention Risk Factor Interview Scale [TIRFIS]) and cultural competency (Tobacco Beliefs Management Scale-Tobacco Cultural Concerns Scale [TBMS-TCCS]), were tested for internal and interrater reliability and sensitivity to varied student performance. Costs of the program were measured.

Results

SPIs highly rated the content, organization, and presenters of the training program. Medical students positively evaluated their experience with the SPIs. The TIRFIS and TBMS-TCCS subscales demonstrated good internal reliability, and inconsistencies in ratings by different SPIs were minimal. In addition, a range of scores on both measures attest to the sensitivity of the instruments to assess variations in student performance. Significant start-up costs are associated with developing this training program, although costs decline when SPIs are retained long term.

Conclusions

The SPI training program was effective in developing a cohort of knowledgeable and reliable SPIs to train medical students in ways to improve their tobacco intervention counseling skills. Retaining SPIs long term should be a primary goal of implementing a cost-effective, successful training program.

Abstract

Tobacco use is the leading cause of preventable death in the United States. Despite the well-known health hazards of tobacco, about one fourth of the US population smokes cigarettes.¹,2 In addition, cigarette and smokeless tobacco use may be increasing among certain demographic groups,³–7 and the national per capita consumption of smokeless tobacco has tripled in the past several decades.⁸ Most smokers would like their health care provider to help them quit smoking, but clinicians often feel inadequately trained to provide the help that addicted tobacco users need.⁹–12 In fact, research has documented that US medical schools are inadequately preparing graduates to deal with tobacco dependence.⁹,10

Explicit national guidelines are available to train physicians in tobacco cessation.¹³ Various methods, such as the traditional didactic approach, patient-centered methods, role playing, and the use of standardized patient instructors (SPIs), have also been developed and used with varying degrees of success in training medical students in tobacco cessation counseling.¹⁰ Using SPIs is a method that has proven especially successful.¹⁴–18

SPIs are lay individuals trained to act as patients to teach medical students, residents, and physicians history-taking skills and interviewing and counseling techniques. Few resources are available, however, to train these lay individuals to become tobacco-specific SPIs who can reliably and effectively integrate into medical education. As a result, medical educators rely on their own knowledge and skills to provide such training and evaluation of their SPI program(s). This article describes the training, use, and evaluation of tobacco-intervention SPIs in undergraduate medical education at Wake Forest University School of Medicine (WFUSM).

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