The effectiveness of using standardized patients to improve community physician skills in mammography counseling and clinical breast exam

Background. Traditional didactic continuing education is relatively ineffective in improving physicians' clinical skills. We hypothesized that a centralized course including small group workshops utilizing standardized patients could improve clinical skills for a reasonable cost. Methods. We designed a 5-h course aimed at improving physicians' counseling skills (re: screening mammography) and clinical breast exam (CBE) skills. The course included lectures, demonstrations, and small group skills sessions utilizing standardized patients and was offered to 156 typical community-based primary care physicians. Pre- and postcourse evaluation included in-office assessments of physician CBE and counseling performance by standardized patients and a written test of knowledge and attitudes. Results. A total of 54.5% of eligible physicians participated. They improved modestly in only one of three areas of counseling skills measured (providing counseling appropriate to the patient's readiness to accept mammography, P = 0.01). The overall CBE score increased substantially from 24.8 to 34.7 (P < 0.0001), Knowledge in all areas measured and confidence in counseling patients also increased. The basic course cost $202 per physician trained. Conclusions. Most community-based primary care physicians may find small group training anti in-office evaluation involving standardized patients acceptable. Such training may be more effective in improving physical exam skills than complex communication skills. (C) 1999 American Health Foundation and Academic Press.