Adolescent-Parent Dyad and Adolescent Eating Disorders: A Standardized Patient Simulation

Many medical students are uncomfortable with adolescent patients and the associated difficulties of navigating speaking with an adolescent alone while ensuring confidentiality. To address this, students are encouraged to effectively use the home, education and employment, eating, activities, drugs, sexuality, suicide/depression, and safety (HEEADSSS) assessment, which is a history-taking method designed to reveal information about a patient's home life, social life, and self-image. We created this observed structured clinical examination (OSCE) for learners to practice their communication skills and improve their comfort in seeing adolescents. In this case, learners interviewed an adolescent female with an overbearing mother, which adds yet another level of difficulty. Medical students practised history and physical exam skills as well as developed a differential diagnosis related to the chief complaint of the OSCE.  Methods: All 118 third-year medical students at a large academic medical institution in 2023-2024 participated in this OSCE. The OSCE was designed as a 25-minute interview of an adolescent and mother standardized patient (SP) pair. The learners were instructed to identify three differentials whilst navigating a tense adolescent-parent dyad. Students were evaluated by their faculty preceptor and SP. Acceptable differentials identified by faculty were quantified (mean and standard deviation) to assess student success in the OSCE. SP feedback was reported to gauge overall student performance.  Results: The response to this OSCE has been very positive. On average, students identified 2.24 correct differentials with a standard deviation of 0.71 differentials. On feedback forms, standardized patients (SPs) indicated that students met or exceeded expectations in 92% of encounters for partnership, 86% for empathy, 84% for apology, 93% for respect, 92% for legitimization, and 83% for support. While students admit the OSCE can be challenging, they also recognize the realism in the case and appreciate the opportunity to practice their skills. Students were able to take focused histories, perform focused physical exams, and create a list of relevant differential diagnoses. They also learned through experience and preceptor feedback about the importance of speaking privately to adolescents, maintaining confidentiality, and using the HEEADSSS assessment.  Discussion: This OSCE has provided an opportunity to increase medical students' exposure to difficult adolescent scenarios and their ability to identify a wide breadth of potential diagnoses. It also encouraged students to build their skills in rapport-building and navigating challenging patient-family dynamics. Implementing direct feedback from SPs, either as a debrief or included in the preceptor rubric, would give students more access to adopt constructive feedback. The simulation could be similarly implemented in the training of interns and junior residents from pediatrics, internal medicine-pediatrics, family medicine, or psychiatry as well.