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Internal Medicine Residents' Attitudes Toward Simulated Depressed Cardiac Patients During an Objective Structured
Kathleen Crapanzano1, Dixie Fisher2, Rebecca Hammarlund3
1Department of Psychiatry, Louisiana State University Health Sciences Center, Baton Rouge, USA. Kcrap1@lsuhsc.edu.
Journal of General Internal Medicine
|January 18, 2018
Summary
Physician bias toward depression did not affect clinical skills in an objective structured clinical exam (OSCE). However, residents examining depressed patients showed lower history-taking skills and more negative facial expressions.
Area of Science:
- Medical Education
- Psychiatry
- Internal Medicine
Background:
- Physician biases towards mental health conditions, such as depression, can negatively impact patient outcomes.
- Understanding these biases is crucial for improving healthcare quality and patient safety.
Purpose of the Study:
- To investigate the association between internal medicine residents' explicit bias towards depressed patients and their clinical performance during an objective structured clinical exam (OSCE).
- To assess how patient depression status influences residents' clinical skills and non-verbal communication.
Main Methods:
- A prospective, parallel randomized controlled study involving 185 internal medicine residents.
- Residents were randomized to interact with a standardized patient (SP) presenting with chest pain, who was either depressed or not depressed.
- Clinical skills (history-taking, physical examination, counseling, diagnosis, workup) and facial expressions were assessed during the OSCE. Resident bias was measured using the Medical Condition Regard Scale (MCRS).
Main Results:
- No significant correlation was found between residents' explicit bias and their overall clinical skill performance.
- Residents evaluating the depressed SP demonstrated significantly lower scores in history-taking and higher scores in patient-physician interaction (PPI) compared to those evaluating the non-depressed SP.
- Facial recognition analysis revealed more neutral expressions from residents interacting with non-depressed SPs and more disgusted expressions from those interacting with depressed SPs.
Conclusions:
- Explicit bias did not predict OSCE performance in this cohort.
- While bias itself didn't correlate with skill scores, differences in performance and non-verbal communication were observed between the depressed and non-depressed patient scenarios.
- Further research is warranted to explore the impact of patient mental health on physician examination, diagnostic processes, and ultimate patient outcomes.