MedEdPORTAL (Sep 2014)
Using SPs to Teach About Patients at Risk For Drug Abuse
Abstract
Abstract Introduction Among chronic pain sufferers, there is a growing problem with prescription drug abuse. This has led to an increased number of patients visiting primary care physicians for pain medication prescriptions and an increased number of patient visits to emergency departments. In addition, millions of Americans abuse prescription drugs for nonmedical purposes, adding substantially to the problem. These standardized patient (SP) cases with checklists provide a tool to help providers practice important clinical skills in screening, monitoring, and treating patients with chronic pain who use prescription drugs. The target audience is any health care professional student (medical, advanced practice nurse, nurse practitioner, and physician assistant), medical residents, or practicing health care providers. Methods Two SP cases were developed for each of the following categories: screening, low risk, and high risk. One set of cases was used for the pretest, the other set for the posttest. For the pretest, participants saw three patients, one in each category. For the posttest, participants again saw three patients, one in each category. Participants had a couple of minutes to read the chart and patient encounter tasks prior to entering the exam room. Tasks could include screening and assessing for risk of prescription drug abuse, giving patient test results, and discussing next steps in pain management. Fifteen minutes were allotted for each patient encounter. After the learner completed the patient visit and left the room, each SP completed a checklist about the learner. Clinical skills that were evaluated included communication, history taking, sharing information and counseling. In addition, SPs rated the learner in overall performance on a 15-point scale from poor to outstanding. Results The cases were originally created for use as the primary assessment measure in a randomized interventional study. Study participants were clinicians or health care professional students assigned to either the intervention or control group. The purpose of the study was to see if a self-study computer-based simulation educational program would help improve learners' ability to screen and manage patients with chronic pain. Study results were mixed, possibly due to poor compliance and attrition. However, the educational value of the SP cases was noted in qualitative responses from study participants. Discussion It is important to highlight to learners the purpose of each case before they begin the patient encounter. The focus should be on communication and patient management. The high-risk case seems the most difficult, which may shape the order in which cases should be administered. It may be best for learners to experience all three categories in a sequential manner to maximize their learning. If time and cost are factors, group sessions can be created.
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