Teaching risk-factor counseling skills: a comparison of two instructional methods

The effectiveness of a class-wide lecture coupled with small group discussions was compared to the outcome of clinical instruction provided by patient instructors (PIs) who were specially trained to teach behavioral counseling skills for health promotion and lifestyle risk-factor modification. PIs are nonprofessionals trained to simulate a medical encounter in order to evaluate clinical competency and provide individual feedback. Each PI enacted the role of an ambulatory patient at high risk for coronary artery disease because of the presence of multiple risk factors. Two groups of medical students were studied using the entire second-year class in two consecutive academic years. In group 1 (n = 92), students received a lecture on risk-factor modification and attended a small group discussion. In group 2 (n = 91), students performed the PI exercise as their primary source of risk-factor counseling instruction. Six months after receiving the initial instruction (at time 2), all students completed the clinical exercise with the PI, who objectively rated each student's counseling skills using the University of Rochester Risk Factor Interview Scale (URRFIS). Differences between groups 1 and 2 at time 2 were significant for total URRFIS and all subscale scores, indicating that students who had received PI training as their form of instruction performed the risk-factor counseling more skillfully. For students in group 2, within-student performance from time 1 to time 2 also was significantly improved. This study demonstrates that instruction in risk-factor counseling for medical students who are early in their formal medical training may be taught more effectively by PIs; the learning appears durable when measured six months after instruction.