Using Adolescents to Train Residents and Medical Students on

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					Using Teen Actors to Teach
 How to Communicate with

            Anisha Abraham, MD, MPH
   Associate Professor, Department of Pediatrics
      Chief, Section of Adolescent Medicine
         Georgetown University Hospital
                 Washington, DC

To review two programs involving teen actors from local
community organizations: Teens Against the Spread of
AIDS (TASA) and Teens and Theater/Duke Ellington
School of Arts
To discuss the benefits of programs using role play with
teen actors in teaching trainees how to communicate
with adolescents
             Teen Actors-TASA

TASA-group of DC high school students who use theater
techniques to educate youth/families about health issues
and based at Children’s National Medical Center
In 1997, workshop developed to improve trainee
violence screening skills at CNMC
Workshop used TASA members as teen actors and
Screening Teens for Violence Risks
- Medical students & pediatric residents rotating thru the
  adolescent clinic at CNMC
- Trainees received a brief didactic lecture on violence among
  teens including FISTS screening tool (Fights, Injuries, Sexual
  Violence and Self-Defense Strategies)
- Did one-on-one role play w/ teen actors on violence related
- Engaged in a panel discussion w/ teens regarding violence risks
  at home, school and the community
 Screening for Teen Violence Risks
Teen Actors
– TASA members developed their own violence
  scenarios including date rape, domestic violence, etc
– Performed 20 min role play w/ trainees, then gave
  feedback to trainees on establishing confidentiality,
  use of FISTS screen, identification and management
  of problem
– Engaged in an interactive panel discussion
  addressing violence issues at home, school, and
Screening for Teen Violence Risks
    Led to study assessing impact of workshop on
    trainee violence screening skills
–     Abraham A, Cheng T, Wright J , et al. Assessing an
      Educational Intervention to Improve Physician Violence
      Screening Skills Pediatrics 2001; 107: p 63-73
  Study: “An Educational Intervention to
 Improve Physician Violence Screening”

• Purpose- To evaluate a violence prevention
  program targeted at health care personnel
• Setting- Adolescent clinic of a tertiary care hospital
• Participants- Med students and peds residents
  assigned to an adolescent rotation
• Intervention- On alternate months, trainees
  received 3 hr workshop on violence prevention
  including use of FIST screening tool & role play w/
  teen actors
 Study: “An Educational Intervention to
Improve Physician Violence Screening”
 Evaluation Methods
  – All participants interviewed a standardized patient
    (teen actor) c/o a persistent headache w/ an
    underlying violence- related issue during their clinical
  – Participants were not aware that the standardized
    patient was an actor and not a real patient
  – Participants completed pre and post rotation
    questionnaires. Teen actors completed an evaluation
    of the encounter
                             Study Design

Beginning of rotation                                End of rotation

Intervention Group-Violence Workshop--Standardized patient
Pre-rotation questionnaire                       Post-rotation questionnaire
                                              Standardized patient evaluation

Control Group-----------------------------------------Standardized patient
Pre-rotation questionnaire                      Post-rotation questionnaire
                                              Standardized patient evaluation
 Study: “An Educational Intervention to
Improve Physician Violence Screening”
 Results- Post-rotation intervention subjects
  – More screening of fighting history (p < .003)
  – Perceived importance in asking about access/ use of
    weapons (p< .02)
  – More screening of violence in school/neighborhood
    (p< .01)
  Standardized Patient Evaluation



Mean score
      10                                                               Control(n=30)


             FISTS use(p<.02)   Identification and   Interpersonal
                                  Management of        Skills(p<.04)
 Study: “An Educational Intervention to
Improve Physician Violence Screening”
  – A violence prevention education program using teen
    actors improved participants’ violence questioning
    and perceived comfort and importance in violence
  – Improved identification and management of a
    standardized violence-related scenario
 Screening for Teen Violence Risks
Taking it on the road
– Conducted workshops with TASA at the National AAP
  conference in DC (1999), National ER conference in
  DC, the International Adolescent Health Conference
  in Lisbon, Portugal (2005), Georgetown University
  Hospital, National Naval Medical Center, etc.
             Duke Ellington/Teens
                 and Theater

“Communicating with Teens Workshop” at GUH
 started in 2006 & involves teen actors from:
 The Improvisation Group/Theater Program at the
 Duke Ellington School of the Arts
  – The only DC public high school providing professional
    arts training & college preparation
 Teens and Theater
  – A group of home-schooled high school students from
    the DC area that are involved in improvisational
Communicating with Teens Workshop
             at GUH

 – 3rd yr med students in pediatric clerkship & peds
   residents in adolescent rotation
Workshop Content
 – Overview of SSHADESS assessment (Strengths,
   School, Home, Activities, Diet, Drugs, Emotions,
   Sexuality, Suicidality and Safety)
 – Tips on talking to teens & establishing confidentiality
 – Interactive role play w/ teen actors
Communicating with Teens Workshop
Teen Actors
 – Create scenarios/perform 20 min role plays with
   groups of med students & residents
 – Scenarios topics involve drug use, depression,
   gender identity, eating disorders,etc
 – Give feedback on use of confidentiality,body
   language, SSHADESS screen, ability to identify chief
   complaint & manage issue
 – Attending and pediatric residents give feedback
   regarding communication techniques and
   management of issue
Communicating with Teens Workshop
(Video clip)
Communicating with Teens Workshop

2007-2008 Study
 – “An Educational Intervention to Improve Physician Interviewing
   Skills of Adolescent Patients during the Pediatric Clerkship”
   involving 150 medical students
Study conclusion:
 – Students report increased confidence & skills in communicating
   w/ teens when participating in interactive workshop as compared
   to lecture alone
Workshop as curriculum
 – As a result of positive evaluations by trainees and results of
   study showing benefit, workshop has become regular part of
   pediatric medical student curriculum; conducted every 6 weeks
Communicating with Teens Workshop

Reaching larger audiences
 – Conducted workshop at 2009 American Academy of
   Pediatrics National Conference (DC)
 – Created sexual history-taking pod cast with teen actor
   available at AAP website
 – Received invitations to take workshop to area
   hospitals & organizations
Teen and Theater/Duke Ellington Funding
– Initially from $25,000 hospital education grant to
  enhance medical student teaching
– Under grant, $600/workshop for coordinator/school
– Currently $150/ workshop for approx 8 teens/
  coordinator- paid by Pediatric Department
– At National conference-teen actors received $50/
  workshop from AAP
TASA Funding
– Received primary funding from grants including
  Washington AIDS Partnership , GEICO, CNMC’s
  Child Health Center and Board of Visitors
Using Teen Actors: Lessons Learned
Scheduling student actors can be challenging
 – to avoid missing classes, tests, performances
Initial development of scenarios requires time and
extensive training
Workshops can be dependent on scenarios and actors
and experience of facilitator
Funding necessary but costs are reasonable
Using Teen Actors: Lessons Learned
Using teen actors from the community can be a very
rewarding experience for actors, facilitators and trainees!
Model is easily adaptable
Pilot studies show interactive role play improves
trainees’ educational experience
Teen actors can also train medical faculty, non medical
Actors once trained can be used for many other
adolescent health topics i.e. substance use, pregnancy
prevention, etc.

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