Small-group, online, actor-as-instructor clinical interview training: a single-blind, randomised controlled study.

Abstract

Background: The use of actors as standardised patient-instructors (SPI) in clinical interview training in the psychiatry module of the medical curriculum is welcomed by medical students. This study aims to examine the effectiveness of this training in enhancing medical students' psychiatric interview skills.

Methods: This was a single-blind randomised controlled study with two arms. Between 17 July 2023 and 26 January 2024, year 5 medical students of The Chinese University of Hong Kong who were studying the psychiatry module and had completed the introductory lecture on clinical interview skills were invited to participate. Participants were asked to rate (1) the helpfulness and adequacy of the existing clinical interview training and (2) their confidence in implementing the clinical interview skills. Participants were then randomly assigned to the intervention group or the control group. Participants in the intervention group received a single clinical interview training workshop through a teleconference platform around mid-module, whereas participants in the control group received teaching as usual. Each workshop involved one trained SPI and two students and lasted for 2 hours. Students engaged in two psychiatric scenarios (post-traumatic stress disorder and delusional disorder). The actor interacted with the students and then provided feedback and guidance based on the four key learning points, namely respectful and sincere attitude, attunement, reflective listening, and empathetic understanding. While one student was practising with the actor, the other student observed and provided peer feedback. Outcome measures included the interview skill sub-score and total score of the Objective Structured Clinical Examination (OSCE) at the end of the module, as well as perceptions of participants on the workshop.

Results: Of 279 eligible students, 112 were randomly assigned to either the intervention group (n=58, 52% female) or the control group (n=54, 52% female). The intervention and control groups were comparable in terms of module-end written examination score, interview skill sub-score of OSCE, and total score of OSCE. Despite this, participants provided highly positive feedback for the clinical interview training using the SPI approach, and 98.3% considered that the session had a positive effect on clinical communication skills. Nonetheless, the post-workshop confidence levels of participants were not correlated with the interview skill sub-score or the total score of OSCE. Similarly, participants' perceived positive feedback of the workshop was not correlated with the Interview skill sub-score or the total score of OSCE.

Conclusion: Small-group online clinical interview training using the SPI approach is welcomed by students. Positive subjective outcomes may not match with objective outcomes. Further studies are needed to establish the benefit of the SPI approach.