Council on Medical Student Education in Pediatrics


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COMSEP 2005 North Carolina Meeting

Poster Presentation:

Reliability of the Structured Communication Adolescent Guide (SCAG) with Untrained Adolescents - Impact on Use in Clerkship


 Blake K, Kutcher M, Wakefield S, Murphy J, Mann K

 Institution: Dalhousie University, Halifax, Nova Scotia, Canada


Introduction: The Structured Communication Adolescent Guide (SCAG) is a reliable and valid instrument used by Standardized Patients (SP's). However, is the SCAG valid when used by untrained adolescents, therefore enabling clerks to be formally rated by their adolescent patients?

Methods: Participants (N=199, mean age=13.39 years+/- .941) included male (N=102) and female (N=97) adolescents from six classes at four Junior High Schools. The study took place in each home room class and lasted approximately one hour. The adolescent participants used the SCAG to rate a videotaped interview featuring a student doctor SP-adolescent clinical interview. Each participant also completed and returned a semi-structured feedback questionnaire. Intraclass correlation coefficients (ICCs) were used to assess inter-rater reliability for overall SCAG scores, and the four SCAG sections. Between-subjects ANOVAs were used to test for main effects of age, sex and school, using total SCAG score, and each section score as dependent variables.

Results: Inter-rater reliability was high for overall SCAG scores (ICC = .996) and for each SCAG section (ICC range .952-.995). No significant main effects of age, sex or school were found for the total SCAG scores, nor were there any significant interactions.

Conclusion: The SCAG is a highly reliable assessment form when used by untrained adolescents. These results strongly support the use of the SCAG by adolescents to provide valid ratings on the clerks' performance. This method is faculty independent and can be used to show that every clerk has interviewed and received feedback from an adolescent patient.

The SCAG and its use in medical education will also be presented:

The Structured Communication Adolescent Guide (SCAG) has four sections (Getting started, Gathering information, Adolescent alone, Wrap-up) each with a general rating The SCAG has been used for five years in the following settings:

  1. In a lecture the audience can watch a live or taped demonstration of adolescent interviewing. The audience then scores the interview using the SCAG.
  2. Medical students interview and obtain written feedback (using the SCAG) from adolescent patients about their performance
  3. In an OSCE setting the adolescent (using the SCAG) scores the trainee
  4. For remedial work. Adolescent SP's can be trained in a scenario and the adolescent independently scores the interview using the SCAG. The faculty member has a structure score of the learner without observing the complete interview.

There is great potential for the use of this instrument in the clerkship and the Paediatric office setting for formative feedback.