CONTEXT: A contextual error occurs when a physician does not identify elements of a patient's environment or behavior, such as access to care, that must be addressed to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients. OBJECTIVE: To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors. DESIGN, SETTING, AND PARTICIPANTS: Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n = 124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010 participated and were assessed. INTERVENTION: A 4-hour course on contextualization. MAIN OUTCOME MEASURES: Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant and were adjusted for subinternship site, academic year, time of year, and case scenario. RESULTS: Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87%-94% ] vs 62% [95% CI, 54%-69%], respectively) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57%-81%] vs 22% [95% CI, 12%-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75%-85%] vs 81% [95% CI, 76%-86%]) or developing appropriate treatment plans for standardized patients with medical issues (54% [95% CI, 42%-67%] vs 66% [95% CI, 53%-79%]). CONCLUSION:Medical students who underwent aneducational intervention were more likely to contextualize care for individual standardized patients.
RCT Entities:
CONTEXT: A contextual error occurs when a physician does not identify elements of a patient's environment or behavior, such as access to care, that must be addressed to appropriately plan care. Research has demonstrated that contextual errors can be identified using standardized patients. OBJECTIVE: To evaluate an educational intervention designed to increase physicians' skills in incorporating the patient's context in assessment and management of care and to thereby decrease the rate of contextual errors. DESIGN, SETTING, AND PARTICIPANTS: Quasi-randomized controlled trial, with assessments by blinded observers. Fourth-year medical students (n = 124) in internal medicine subinternships at the University of Illinois at Chicago or Jesse Brown Veterans Administration Medical Center between July 2008 and April 2009 and between August 2009 and April 2010 participated and were assessed. INTERVENTION: A 4-hour course on contextualization. MAIN OUTCOME MEASURES: Probing for contextual issues in an encounter, probing for medical issues in an encounter, and developing an appropriate treatment plan. Outcomes were assessed using 4 previously validated standardized patient encounters performed by each participant and were adjusted for subinternship site, academic year, time of year, and case scenario. RESULTS: Students who participated in the contextualization workshops were significantly more likely to probe for contextual issues in the standardized patient encounters than students who did not (90% [95% confidence interval {CI}, 87%-94% ] vs 62% [95% CI, 54%-69%], respectively) and significantly more likely to develop appropriate treatment plans for standardized patients with contextual issues (69% [95% CI, 57%-81%] vs 22% [95% CI, 12%-32%]. There was no difference between the groups in the rate of probing for medical issues (80% [95% CI, 75%-85%] vs 81% [95% CI, 76%-86%]) or developing appropriate treatment plans for standardized patients with medical issues (54% [95% CI, 42%-67%] vs 66% [95% CI, 53%-79%]). CONCLUSION: Medical students who underwent an educational intervention were more likely to contextualize care for individual standardized patients.
Authors: Carolina J P W Keijsers; Larissa van Hensbergen; Lotte Jacobs; Jacobus R B J Brouwers; Dick J de Wildt; Olle Th J ten Cate; Paul A F Jansen Journal: Br J Clin Pharmacol Date: 2012-11 Impact factor: 4.335
Authors: Carolina J P W Keijsers; Johanna E de Wit; Jelle Tichelaar; Jacobus R B J Brouwers; Dick J de Wildt; P G M de Vries; Paul A F Jansen Journal: Eur J Clin Pharmacol Date: 2015-03-11 Impact factor: 2.953
Authors: Robert F Kushner; Linda Van Horn; Cheryl L Rock; Marilyn S Edwards; Connie W Bales; Martin Kohlmeier; Sharon R Akabas Journal: Am J Clin Nutr Date: 2014-03-19 Impact factor: 7.045
Authors: Jeffrey D Colvin; Jessica L Bettenhausen; Kaston D Anderson-Carpenter; Vicki Collie-Akers; Laura Plencner; Molly Krager; Brooke Nelson; Sara Donnelly; Julia Simmons; Valeria Higinio; Paul J Chung Journal: Acad Pediatr Date: 2015-07-14 Impact factor: 3.107
Authors: Conor Gilligan; Martine Powell; Marita C Lynagh; Bernadette M Ward; Chris Lonsdale; Pam Harvey; Erica L James; Dominique Rich; Sari P Dewi; Smriti Nepal; Hayley A Croft; Jonathan Silverman Journal: Cochrane Database Syst Rev Date: 2021-02-08