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Influence of Patient Demeanor on Clinical Performance and Medical Education: Results From a Clinical Simulation Pilot Study
*Andrew J Eyre, Ted A James, *Cate Nicholas
University of Vermont College of Medicine, Burlington, VT

Objective: This pilot study was designed to investigate how variations in provider-patient interactions affect the performance of technical and non-technical skills during a simulated laceration repair exercise.
Design: Randomized control trial, survey
Setting: Simulated emergency department treatment area
Participants: Twenty-four third-year medical students completing a non-graded laceration repair exercise using a hybrid simulation model (synthetic suture pad attached to standardized patient) during their surgery clerkship final examination.
Interventions: Students were randomized to complete a simulated laceration repair station with either a pleasant or disagreeable patient.
Main Outcome Measures: The main outcome measures were student performance of technical and non-technical skills as well as student survey responses.
Results: Students encountering disagreeable patients were less likely than those working with agreeable patients to gather an appropriate history (Medical history 36% vs. 69%, Medications 36% vs. 69%, Allergies 27% vs. 30%, Tetanus 18% vs. 30%) and perform necessary physical examination elements (motor function 27% vs. 38%). Students in the disagreeable group felt more nervous (Likert scale 2.8 vs. 3.6, 1=very nervous and 5=not nervous at all) and felt the station to be of less educational benefit (Likert scale 2.9 vs. 3.1 with 1=no benefit and 5=great benefit). Both groups reported that they would have valued attending feedback on their performance, yet students in the disagreeable group were less interested (Likert 3.7 vs. 4.1, 1=no value and 5=great value).
Conclusions: When treating disagreeable patients, even in a simulated environment, students are less likely to perform appropriate history and physical exam elements. These findings have impact for patient safety. Additionally, students working with difficult patients report feeling more nervous and are less likely to achieve educational value from clinical interactions.


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