Lecture versus standardized patient interaction in the surgical clerkship: a randomized prospective cross-over study

Medical schools increasingly are incorporating the standardized patient (SP) interaction as a teaching and testing modality to prepare students for United States Medical Licensing Examination Step 2 Clinical Skills. Although SP interactions provide a safe environment in which to practice clinical skills, little is known about medical students' perceptions of the instructional SP interaction in comparison with the classic didactic lecture. We hypothesized that students would enjoy and value an instructional SP interaction more than a didactic lecture, and that this perception would be enhanced if the lecture immediately preceded the instructional SP interaction.

Students on the junior surgery clerkship from January to December 2004 were randomized into 2 groups. Group A (n = 71) received an hour-long didactic lecture about peripheral vascular disease followed by a 20-minute instructional SP interaction in which the SP portrayed a patient with lower-extremity claudication. Group B (n = 72) received the SP interaction first, followed by the lecture. All students received an identical quiz about peripheral vascular disease after the second educational encounter, whether the SP interaction or the lecture. Student perceptions were surveyed by written questionnaire before and after the session by using a 5-point Likert scale, with 5 being the most favorable rating. Data (perceptions, performances on the quiz and the SP interaction, clerkship grades) were compared using the Student t test or the Mann-Whitney rank sums test.

Although all students on average enjoyed and valued the lecture more than the SP interaction (P <.001), group A students enjoyed the SP interaction more than group B (3.3 +/- .9 vs. 2.8 +/- 1.0, P = .008), and they perceived the SP interaction as having more value to their overall education (3.3 +/- 1.0 vs. 2.8 +/- 1.0, P = .004). Group A students performed statistically better on the physical examination (66% +/- 19% vs. 40% +/- 16%, P <.001) and communication portions (90% +/- 11% vs. 79% +/- 12%, P <.001) of the SP checklist than group B, but not on the history portion. Student confidence in their own history and physical examination skills increased similarly for both groups.

The classic lecture format not only is enjoyed and valued as a learning tool more by our surgical clerkship students than the instructional SP interaction, but having a lecture just before an SP interaction increased perceived enjoyment and value of the SP interaction and enhanced performance on the SP checklist. These data suggest that educators can improve student perceptions and attitudes surrounding the instructional SP interaction by using strategically timed lectures.