Sarah E Winters, MD1; Debra Hillman1; Denise LaMarra2; Judy Shea, PhD2; David Rubin, MD, MSCE 1
1The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
2University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Background: The use of Standardized Patients (SP) for evaluation of medical students presents an opportunity to test whether students adequately assess psychosocial concerns.
Objective: 1) To estimate proportions of students who identified maternal depression and Intimate Partner Violence (IPV) in a SP with failure to thrive (FTT).2) To identify characteristics of students and SPs that increase identification of Depression/IPV.
Design/Methods: At the end of clinical clerkships 112 students interviewed a SP with a child with FTT. The etiology of the FTT was inadequate caloric intake secondary to maternal depression and IPV. Adequacy of student assessment for IPV and maternal depression was based on inquiry about six related issues, including identification and counseling. Student characteristics were obtained from medical school admissions data.
Results: 53 % of students were female and 17 % were underrepresented minorities. 66% of students identified depression and 32% identified IPV during the assessment. Analysis of student/SP characteristics and exam results showed that underrepresented minorities were more likely to identify ¾2/6 issues related to depression or maternal IPV than non-minority students (95% vs. 74%, p<0.05). There was a trend for women to more frequently identify ¾2/6 of these relevant problems (85% vs. 70%, p=0.058).
Conclusions: Despite curricula that address IPV and depression, there continue to be gaps in student identification of these problems. Minority students scored higher on parts of the SP exam related to IPV/depression. This suggests that recruitment of a diverse student body or curricular improvements may be important in increasing recognition of these issues.