Post-Graduate Adolescent Interviewing Skills: A Reflection of the Sustainability of Structured Formal Undergraduate Training

Introduction : In adolescence, individuals begin to assume responsibility for their own health care. Hence, effective adolescent interviewing and communication by physicians are critical. Education in this area occurs usually in undergraduate medical education (UME); whether these skills are maintained in residency is unclear. Our objective was to determine if entry level residents (PGY1) who had received formal adolescent interview training (with standardized patients and structured feedback) in UME achieved higher scores on a validated rating scale, the Structured Communication Adolescent Guide (SCAG)1,2, than those who had not received formal adolescent interviewing training. Methods: PGY1s, including international medical graduates, were recruited. Each participant conducted an adolescent interview with a standardized adolescent patient and mother pair (SPs). The themes of the patient case focused on sensitive subjects to adolescents, specifically sexual orientation and bullying. The SPs separately scored residents on their interview using the 29 item SCAG comprised of four sections (Getting started, Gathering Information, Teen alone, and Wrap up) each with a total item score and global score. Unpaired t-tests were conducted to compare the total item and global SCAG scores of the ‘no formal training’ group against the ‘formal training’ group, using the SP Daughter score and Mother score separately. Unpaired t-tests were also conducted to determine if there were statistical differences between daughter and mother scoring. Results: PGY1’s who had received previous formal training (n= 23) had statistically significantly higher scores than those without (n= 29) on both the Total Item scores (maximum 58) and the Global scores (maximum 40). No Formal Training SP Adolescent: Total-Item Score Mean (SD) 32.41 (10.12) Global Score Mean (SD) 26.10 (6.22) Formal Training SP Adolescent: Total-Item Score Mean (SD) 40.78 (7.04) Global Score Mean (SD) 30.83 (3.33) Significance: Total-Item Score P<0.0013 No Formal Training SP Mother: Total-Item Score Mean (SD) 33.34 (10.90) Global Score Mean (SD) 25.41 (7.74) Formal Training SP Mother: Total-Item Score Mean (SD) 40.48 (7.90) Global Score Mean (SD) 29.61 (5.92) Significance: Total-Item Score P<0.0347 The areas where training had the biggest impact were: separating the teen and mother and the “teen alone section” which included suicide, moods, safe sex and contraception, recognizing that there were other issues and discussing confidentiality. Scores given by the SP mother and Daughter did not differ significantly. P values ranged from P<0.8933. Discussion: Our results suggest that PGY1s who had formal adolescent training in UME had retained the knowledge base and communication skills to interview an adolescent as they entered residency. These skills can be further built on in residency. Agreement between the mother and daughters’ scores provides inter-rater reliability to the scale, further validating the tool. Conclusion: We demonstrated, using an established scale, that there was a sustainable effect of structured training in adolescent interviewing into postgraduate performance. Our findings support the need for formal adolescent training in UME. We suggest that PGY1s with no formal adolescent training should receive SP interviewing with adolescent feedback.