MedEdPORTAL (Aug 2014)
A Standardized Patient Case: A Teen Questioning His/Her Sexuality is Bullied at School
Abstract
Abstract Introduction Most health care providers feel unprepared to address issues related to sexual orientation with adolescent patients. Adolescents with same-gender attraction or sexual behavior have greater physical and mental health care needs compared to their peers; specifically, these populations have higher rates of suicidal behavior, substance use, and risky sexual behavior, including unprotected sex and sex under the influence. Thus, it is important for medical students to become comfortable discussing sexual orientation and its related sequelae with adolescent patients. Methods This resource is a standardized patient (SP) case focused on interviewing adolescents who are questioning their sexuality. Two to three students each take a turn interviewing an SP over a 45-minute time period. Before the case begins, students are provided with a syllabus that includes supplementary materials regarding some of the techniques and challenges that may arise when interviewing specific patient populations, including LGBT individuals. Medical students participating in the case (either interviewing the SP or observing) and facilitators are surveyed immediately after completing the case to determine whether the educational objectives have been met and whether the case content is considered to be valuable material in our Advanced Medical Interviewing (AMI) curriculum. SPs who play the case are also surveyed about the quality of the case and training materials. Results In all, 139 out of 143 students (97%), 29 out of 29 faculty facilitators (100%), and nine out of 10 SPs (90%) completed surveys. Key areas of interest included communicating with patients about sexual attraction/preferences, communicating with patients about sexual orientation, communicating with patients about sexual behaviors, screening adolescents for depression, screening adolescents for bullying, and interviewing adolescents. The surveys revealed significant improvement in student preparedness for each area of interest. Additionally, most faculty felt that the case helped prepare students to a moderate or large degree for each category. To determine whether the content of the case was perceived to be of value, medical students and faculty members were queried regarding the importance of four topics in medical school training: taking a detailed sexual history, screening adolescents for depression, screening adolescents for bullying, and interviewing adolescent patients. The overwhelming majority of students and faculty members found these areas to be mostly important or very important. Discussion We did not objectively determine whether the case improved learners' skills in interviewing sexual minority adolescents. Because our AMI course focuses on allowing learners to practice interviewing skills in a safe and comfortable environment, learners are provided with formative feedback rather than formally graded on their performance. This case could be adapted for use in clinical clerkships for third- and fourth-year medical students as well as for residents, fellows, and even faculty in certain settings, given the widespread discomfort with discussing sexual orientation with adolescents. However, this case is not recommended for beginning medical students. The case is also not recommended for learners who have not had any exposure to LGBT populations previously in their medical school curriculum.
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