Biomedical subjects

Steven A Haist

Publications and source records attributed to Steven A Haist.

8 recordsLinked to original sources

PubMed2007

Sexual history inquiry and HIV counseling: improving clinical skills and medical knowledge through an interactive workshop utilizing standardized patients.

BACKGROUND: Sexual history and HIV counseling (SHHIVC) are essential clinical skills. Our project's purpose was to evaluate a standardized patient educational intervention teaching third-year medical students SHHIVC. METHODS: A four-hour standardized patient workshop was delivered to one-half of the class each of three consecutive years at one medical school. Approximately 3.5 weeks later, all students engaged in a standardized patient examination including one station assessing SHHIVC, answered an open-ended written exercise following the standardized patient encounter, and completed a written examination including sexual history and HIV-related questions. RESULTS: Workshop participants scored higher than non-participants on SHHIVC items on the standardized patient station (P < .0001), written exam (P < .0001), and open-ended written exercise after the standardized patient encounter (P = .024). CONCLUSIONS: Our SHHIVC curriculum was associated with students demonstrating better clinical skills on a SHHIVC standardized patient examination station and more SHHIVC knowledge on two measures of medical knowledge than students not participating in the SHHIVC educational intervention.

Clinical Competence↗

PubMed2006

Physician colorectal cancer screening recommendations: an examination based on informed decision making.

OBJECTIVE: The purpose of this research was to examine the content of physicians' colorectal cancer screening recommendations. More specifically, using the framework of informed decision making synthesized by Braddock and colleagues, we conducted a qualitative study of the content of recommendations to describe how physicians are currently presenting this information to patients. METHODS: We conducted semi-structured interviews with 65 primary care physicians. We analyzed responses to a question designed to elicit how the physicians typically communicate their recommendation. RESULTS: Almost all of the physicians (98.5%) addressed the "nature of decision" element. A majority of physicians discussed "uncertainties associated with the decision" (67.7%). Fewer physicians covered "the patient's role in decision making" (33.8%), "risks and benefits" (16.9%), "alternatives" (10.8%), "assessment of patient understanding" (6.2%), or "exploration of patient's preferences" (1.5%). CONCLUSION: We propose that the content of the colorectal screening recommendation is a critical determinant to whether a patient undergoes screening. Our examination of physician recommendations yielded mixed results, and the deficiencies identified opportunities for improvement. PRACTICE IMPLICATIONS: We suggest primary care physicians clarify that screening is meant for those who are asymptotic, present tangible and intangible benefits and risks, as well as make a primary recommendation, and, if needed, a "compromise" recommendation, in order to increase screening utilization.

Adult↗

PubMed2005

"Do we really need all that equipment?": factors influencing colorectal cancer screening decisions.

The lifetime risk of developing colorectal cancer is 2.5 to 5% in the general population. Colorectal screening can prevent mortality, and there are a number of screening methods, ranging from noninvasive to highly invasive. Although recommendations have been widely disseminated in the media and scientific journals, screening usage is low. In this project, the authors examine the factors that influence individuals' decisions regarding colorectal screening. They conducted semistructured interviews with 30 people (13 men and 17 women) selected to provide a maximum variation sample. They categorized factors into the following themes: concern for one's personal well-being, competing demands, preparing for the procedure, the screening process, gender concerns, fear of having cancer, feeling healthy, cost, the experiences of others, and turning 50 years old.

Colorectal Neoplasms↗

PubMed2004

Improving students' sexual history inquiry and HIV counseling with an interactive workshop using standardized patients.

Sexual history and HIV counseling are essential clinical skills. Our project's purpose was to evaluate a standardized patient (SP) educational intervention teaching third-year medical students sexual history taking and HIV counseling. A 4-hour SP workshop was delivered to one-half of the class. Four weeks later, all students engaged in an SP examination including one station on assessing sexual history taking and HIV counseling. Workshop participants scored one standard deviation higher on sexual history and HIV counseling items than nonparticipants. Our sexual history and HIV counseling curriculum was associated with students asking more thorough sexual histories and providing more HIV counseling.

Counseling↗

PubMed2003

Clinical skills as demonstrated by a comprehensive clinical performance examination: who performs better - men or women?

PURPOSE: Determine whether gender predicted student performance on a clinical performance examination (CPX) when controlling for pre-matriculation and medical school performance. METHOD: A sixteen-station CPX, utilizing standardized patients (SPs), was administered to the fourth-year students three successive years at one United States medical school. Scores for each student by discipline and skills across stations were generated. Bivariate correlation and multiple regression analyses were performed to determine relationships between students' scores and pre-matriculation information (age, gender, MCAT, and undergraduate GPA) and medical school performance (first-, second- and third-year GPA, and USMLE Step 1). RESULTS: The CPX mean score for all students was 65.1% (SD 6.2). The mean total score for men (n = 182) and women (n = 93) was 64.0% and 67.0%, respectively. Being a woman, positively affected a student's score in two models controlling for pre-matriculation and medical school performance by 2.8% or 0.47 standard deviations (SD) and 2.3% or 0.39 SD, respectively. Women scored numerically higher than men in all seven disciplines (internal medicine, obstetrics/gynecology, pediatrics and psychiatry, p < 0.05) and for nine skills across all stations (introduction, history, physical examination, counseling and interpersonal, p < 0.05). CONCLUSION: Women performed better than men on the University of Kentucky CPX. Being a woman was a positive and independent predictor of performance.

Adult↗

PubMed2003

House staff nonverbal communication skills and standardized patient satisfaction.

OBJECTIVE: To examine the association of physician nonverbal communication with standardized patient (SP) satisfaction in the context of the "quality" of the interview (i.e., information provided and collected, communication skills). DESIGN: Observational. SETTING: One university-based internal medicine residency program. PARTICIPANTS: Fifty-nine internal medicine residents. INTERVIEWING: The 59 residents were recruited to participate in 3 SP encounters. The scenarios included: 1) a straightforward, primarily "medical" problem (chest pain); 2) a patient with more psychosocial overlay (a depressed patient with a history of sexual abuse); and 3) a counseling encounter (HIV risk factor reduction counseling). Trained SPs rated physician nonverbal behaviors (body lean, open versus closed body posture, eye contact, smiling, tone of voice, nod, facial expressivity) in the 3 encounters. Multiple regression approaches were used to investigate the association of physician nonverbal behavior with patient satisfaction in the context of the "quality" of the interview (SP checklist performance, measures of verbal communication skills), controlling for physician characteristics (gender, postgraduate year). RESULTS: Nonverbal communication skills was an independent predictor of standardized patient satisfaction for all 3 patient stations. The effect sizes were substantial, with nonverbal communication predicting 32% of the variance in patient satisfaction for the chest pain station, 23% of the variance for the depression-sexual abuse station, and 19% of the variance for the HIV counseling station. CONCLUSION: Better nonverbal communication skills are associated with significantly greater patient satisfaction in a variety of different types of clinical encounters with standardized patients. Formal instruction in nonverbal communication may be an important addition to residency.

Female↗

PubMed2003

Domestic violence: increasing knowledge and improving skills with a four-hour workshop using standardized patients.

PURPOSE: Domestic violence (DV) is common, yet physicians feel unprepared to address it. Educational interventions may improve the care provided to DV victims, yet the effectiveness of interventions is often unproven. METHOD: Written questions and DV-specific standardized patient (SP) checklist items from an end-of-clerkship and fourth-year comprehensive multispecialty (the Clinical Performance Examination or CPX) examinations of medical students participating in a DV workshop using SPs was compared with nonparticipants. RESULTS: DV workshop participants' and nonparticipants' written question mean scores were 93.2% and 85.8%, respectively, p =.02. End-of-clerkship SP examination DV-specific checklist scores for participants and nonparticipants was 76.3% and 60.0%, respectively, p =.002. Workshop participants scored 44.1% on the CPX DV-specific checklist items versus 35.6% for the nonparticipants, p =.01. CONCLUSION: A DV workshop improved knowledge and skills assessed four and an average of 27 weeks later.

Clinical Clerkship↗

PubMed2003

A model for setting performance standards for standardized patient examinations.

Setting standards for complex performance assessments is difficult. This report describes and evaluates a model for setting performance standards for standardized patient examinations. A variation of a modified Angoff standard-setting procedure was used to set cutoffs for a standardized patient exercise. Analysis of the procedure was based on evaluation of the impact of the iterative process, the ability of the final standards to accurately classify trainees and the judges' confidence in the procedure and final standards. The practicality of the process also was assessed. The iterative steps in this procedure led to a reduction in the variance between the judges' ratings. All seven judges reported confidence in the final standards. The mean time commitment for each judge was 4.7 work hours. This model for setting performance standards successfully set useful standards for this exam, was practical, and can be utilized to set performance standards for other standardized patient examinations.

Clinical Competence↗