Teaching and Assessing Residents' Skills in Managing Heroin Addiction With Objective Structured Clinical Examinations (OSCEs)

Background: Heroin-abusing patients present a significant challenge. Objective Structured Clinical Examinations (OSCEs) allow evaluation of residents' clinical skills. The objective of this study was to examine residents' OSCE performance assessing and managing heroin abuse. Methods: Evaluation and comparison of heroin-specific communication, assessment, and management skills in a 5-station postgraduate year 3 (PGY3) substance abuse OSCE. Faculty used a 4-point Likert scale to assess residents' skills; standardized patients provided written comments. Results: Two hundred sixty-five internal and family medicine residents in an urban university hospital participated over 5years. In the heroin station, residents' skills were better (P < .001 for both comparisons) in communication (mean overall score: 316 +/- 0.51) than in either assessment (mean overall score: 2.66 +/- 0.60) or management (mean overall score: 2.50 +/- 0.73). The mean score for assessing specific high-risk behaviors was lower than the mean overall assessment score (222 +/- 1.01vs. 2.74 +/- .59; P < .0001), and the mean score for recommending appropriate harm reduction management strategies was lower than the mean overall management score (2.39 +/- .89vs. 2.54 +/- .74; P < .005). Standardized patients' comments reflected similar weaknessess in residents' skills. Conclusions: Assessment and management of heroin abuse were more challenging for residents than general communication. Additional training is required for residents to assess and counsel patients about high-risk behaviors.