The effectiveness of using standardized patients to improve community physician skills in mammography counseling and clinical breast exam

Prev Med. 1999 Oct;29(4):241-8. doi: 10.1006/pmed.1999.0544.


Background: Traditional didactic continuing education is relatively ineffective in improving physicians' clinical skills. We hypothesized that a centralized course including small group workshops utilizing standardized patients could improve clinical skills for a reasonable cost.

Methods: We designed a 5-h course aimed at improving physicians' counseling skills (re: screening mammography) and clinical breast exam (CBE) skills. The course included lectures, demonstrations, and small group skills sessions utilizing standardized patients and was offered to 156 typical community-based primary care physicians. Pre- and postcourse evaluation included in-office assessments of physician CBE and counseling performance by standardized patients and a written test of knowledge and attitudes.

Results: A total of 54.5% of eligible physicians participated. They improved modestly in only one of three areas of counseling skills measured (providing counseling appropriate to the patient's readiness to accept mammography, P = 0.01). The overall CBE score increased substantially from 24.8 to 34.7 (P < 0.0001). Knowledge in all areas measured and confidence in counseling patients also increased. The basic course cost $202 per physician trained.

Conclusions: Most community-based primary care physicians may find small group training and in-office evaluation involving standardized patients acceptable. Such training may be more effective in improving physical exam skills than complex communication skills.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Breast Neoplasms / diagnosis*
  • Clinical Competence / standards*
  • Counseling / education*
  • Education, Medical, Continuing / methods*
  • Family Practice / education*
  • Female
  • Health Knowledge, Attitudes, Practice
  • Humans
  • Male
  • Mammography*
  • Mass Screening / methods
  • Palpation*
  • Patient Simulation*
  • Program Evaluation