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S32 Poster Abstracts / 48 (2011) S18–S120

cine-focused standardized patient education module at alearning center for simulated education within a children’shospital. A preventative health (PH) visit and sexually trans-mitted infection (STI) phone case with parent and teen wereconducted. A knowledge tool (17 items for PH, 8 items for STI)was completed by study investigators as they watched theinteractions with video monitoring, rating residents (3-itemscale: fully addressed [FA], not fully addressed [NFA], and notaddressed [NA]). Finally, answers (not confident [NC], some-what [SC], confident [C], very [VC]) to a self-efficacy tool ad-ministered immediately before (PRE) and after (POST) werereviewed for correlations to knowledge levels. Descriptive sta-tistics and �2 tests were used to evaluate relationships (SPSS,8.0; all p � . 05).

Results: For the preventative health case, sexual activity andcontraception were fully assessed less than 75% of the time;between60%and90%of residents never assessedmood, eatinghabits or sleep. Comparing PRE self-efficacy and knowledgeitems, residents confident in interviewing fully addressedschool; residents somewhat confident in asking adolescentsquestions also fully addressed school. Residents not confidentin counseling on STI did not address eating habits. For POSTself-efficacy comparisons, residents somewhat confident inassessing risk fully addressed school, and residents somewhatconfident asking personal questions, fully addressed datingconfidentiality. Residents somewhat confident interviewingteens all fully addressed confidentiality. For the STI case,�80%of residents fully addressed STI diagnosis, but all items wereunaddressed by at least one resident. More than 50% of theresidents did not address STI prevention and partner notifica-tion and �70% did not address contraception. Finally, �50%esidents fully addressed confidentiality with the adolescent,ut �50% addressed confidentiality with the parent. For PREelf-efficacy and knowledge of STI comparisons, most resi-ents confident in confidentiality fully addressed STI preven-ion (p � .05). In POST comparisons, no itemswere significant.onclusions: Resident knowledge of adolescent medicine isarely examined outside of testing situations. Standardizedatient cases allow for increased data and insight into residentbilities, especially related to their own perceptions of knowl-dge. An adolescent medicine rotation additionally allows forontinued resident education in this special pediatric popula-ion.ources of Support: None.

29.

PEDIATRIC RESIDENT COMMUNICATION SKILLS WITHADOLESCENT PATIENTS AND RELATIONSHIP TO SELF-EFFICACYJennifer Woods, MD, MS3, Tracie Pasold, PhD4,eatrice Boateng, PhD2, Devon Hensel, PhD1.

1Indiana University School of Medicine 2UAMS3University of Arkansas for Medical Sciences4University of Arkansas for Medical Sciences/Arkansas Children’s Hospital

Purpose: Pediatric resident communication skills are oftenassessed through supervised patient encounters. One-on-onepatient contact is rarely evaluated, especially in comparison to

personal assessment of self-efficacy. The objectives of this

esearch were 1) to examine resident communication skillsith adolescent patients and 2) to compare resident self-effi-acy against their communication skills.ethods: Pediatric residents (n � 24) beginning their adoles-ent medicine rotation participated in two standardized pa-ient modules at a simulated learning center. A face-to-facease preventative health (PH) case and a phone case address-ng sexually transmitted infections (STI) were performed.tandardized patients completed a 12-item communicationool to rate satisfaction (5-item Likert scale: poor to excellent)ith residents during the encounter. Resident responses (4-

tem Likert: not confident to very confident) to a self-efficacyool before (PRE) and after (POST) themodules were reviewedor correlations to communication levels. Descriptive statisticsnd �2 tests were used to evaluate relationships (SPSS� 18.0;

all p � .05).Results: For the PH case, residents were ‘excellent’ in �50%encounters for introduction, confidentiality, warmth, respect,term explanation and listening; �90% were ‘excellent’ for eyecontact. There were no ‘poor’ ratings for any items. During theteen STI case, residents were ‘excellent’ �50% only for intro-duction; �30% were ‘poor’/‘fair’ for warmth while �20% were‘poor’/‘fair’ for confidentiality, interest, and encouraging ques-tions. For the STI parent case, residents were ‘excellent’ �60%for (not) bored, term explanation, and encouraging questions;however, �30% were ‘poor’/‘fair’ for confidentiality and en-couraging questions. Comparing PRE PH self-efficacy and com-munication items, residents ‘excellent’ for eye contact weresomewhat confident in counseling on contraception. Resi-dents confident interviewing teens POST PH module were‘excellent’ in introduction, confidentiality, and encouragingquestions. Residents confident in asking personal questionswere ‘excellent’ in confidentiality, explaining terms, and en-couraging questions. Residents somewhat confident counsel-ing on contraception were ‘excellent’ at eye contact, residentsconfident in STI counseling were ‘excellent’ explaining terms,and residents confident in pregnancy counseling were ‘excel-lent’ explaining terms. For PRE STI self-efficacy and communi-cation, residents ‘excellent’ in explaining terms to parentswere somewhat confident giving sensitive test results andresidents ‘excellent’ for introduction to adolescents weresomewhat confident discussing STI treatment; both signifi-cant p � .045. No items were significant for POST STI self-efficacy and communication.Conclusions: Resident communication skills are frequentlyassessed in limited situations outside of face-to-face patientencounters. Standardized patient cases allow for increasedinsight into resident abilities and an adolescent medicine ro-tation is a special opportunity for resident education and im-proving interviewing skills with this unique population.Sources of Support: None.

30.

SELF-EFFICACY CHANGES IN PEDIATRIC RESIDENTS WITHSTANDARDIZED PATIENTS AND DURING AN ADOLESCENTMEDICINE ROTATIONJennifer Woods, MD, MS3, Tracie Pasold, PhD4,eatrice Boateng, PhD2, Devon Hensel, PhD1.

1Indiana University School of Medicine 2UAMS

3University of Arkansas for Medical Sciences

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Purpose: Self-efficacy (SE) of the health provider affects themedical care a patient receives. Previous studies have evalu-ated self-efficacy of resident physicians, but the area of ado-lescent medicine has not been investigated, especially in thecontext of standardized patient education modules and anadolescent medicine rotation. The objective of this researchwas (1) to evaluate the self efficacy of pediatric residents asthey begin a month-long rotation in adolescent medicine, (2)to re-evaluate self-efficacy immediately after a simulated pa-tient education module and at the completion of the rotationand (3) to compare changes in self-efficacy over the timeperiod.Methods: Pediatric residents (n � 24) beginning their adoles-cent medicine rotation participated in two adolescent medi-cine-focused standardized patient education modules at alearning center for simulation within a children’s hospital. Aself-efficacy tool was completed by the residents before (PRE)and after (POST) a face-to-face preventative health (PH) visitand a phone-interaction concerning sexually transmitted in-fections (STI). The self-efficacy toolwas completed a third timeat the end of the rotation (END). Resident responses rangedfrom not confident, somewhat confident, confident, and veryconfident. Descriptive statistics and difference in mean t-testswere used to evaluate changes in self-efficacy between timepoints (SPSS, 18.0; all p � .05).Results: For the PH module, residents were very confident�5% for PRE and POST items. Residents were confident or veryconfident �75% for all END items, and �25% residents wereery confident except assessing risk and contraception coun-eling. No residents were unconfident for any item at END. NoRE vs. POST itemswere significantly different for the PH visit,ut all itemswere significantly higher at END vs. PRE and POSTp � .05). The STI module showed residents were confident orery confident �50% PRE items except giving sensitive results.esidents were confident or very confident �50% of all POSTtems except explaining confidentiality to adolescents. At END,90% of residents were confident or very confident for all

tems except discussing treatment of STI. Residents were veryonfident �5% for POST items. Residents were very confident25% at END for all items and �50% explaining confidentialityo adolescents. Twenty-five percent of residentswere not con-dent POST addressing confidentiality to parents, but no resi-ents were unconfident for any item at END for the STI case.or PRE vs. POST STI case comparisons, confidentiality to par-nts (p � .018), giving sensitive test results (p � .05), andounseling on STI prevention (p � .05), were significantlyigher for PRE. Self-efficacy on all items was higher at END inomparison to PRE and POST (p � .05).onclusions: Self-efficacy of pediatric residents is affected byxperiences with standardized patients and their one-monthdolescentmedicine rotation. Examining personal capabilitiesver time allows for both change and acknowledgment ofhange in self-efficacy. Continued education of residents in therea of adolescent medicine will foster this opportunity forearning in an often-overlooked pediatric population, and fu-ure educational interventions with unannounced SPs will al-

ow for further examination of self-efficacy.

ources of Support: None.

31.

DEVELOPING SCREENING AND BRIEF INTERVENTIONS FORPRIMARY CAREWITH ADOLESCENT FEEDBACKJames Hall, PhD, LISW, LCSW-PIP, ACSW1,Douglas Smith, PhD2, Mijin Jang, MA3.1University of Alabama 2University of Illinois3University of Iowa

Purpose:Alcohol use and other risky behaviors by adolescentscontributes tomajor and preventable causes ofmorbidity, andefforts are underway to integrate primary care providers intobroad initiatives designed to reduce the public health burdenof underage drinking. However, the feasibility of providingscreening and brief interventions for adolescent substancemisuse in primary care settings has not been examined invarious settings.We investigatedwhether rural youthwere asamenable to substance misuse screening in primary care set-tings as urban youth.Methods: In this study we compared rural and urban adoles-cent (n� 84) focus group participants’ estimates of adolescentsubstancemisuse prevalence, opinions onwhether health careproviders should screen for adolescent substance misuse, andresponses about whether or not they would be honest withsuch screening. We also compared rural and urban parents’opinions on whether health care providers should screen forsubstance misuse, as well as their comfort with provider dis-cussions with their teens.Results:Overall, themajority of parents (65.9%) indicated theywere comfortablewithproviders havingprivate conversationswith their teens, with no differences between rural and urbanparents. Overall, most adolescents (60.7%) reported theywould be honest if asked about their alcohol and drug use inprimary care, and the remaining responses were evenly splitbetween those that were unsure and those that said theywould not be forthcoming. An overwhelmingmajority (90.5%)of teens said they thought it was part of their health careproviders’ jobs to have discussions with them about alcoholand drugs. Therewere no significant differences between ruraland urban youth on these measures. Both rural and urbanyouth overestimated the prevalence of substance misuse byyouth in the State by an average of 16.4 percentage points.However, rural youthmade significantly higher overestimatescompared to urban teens.Conclusions: Previous findings appear to generalize to ruraladolescents, and brief interventions comparing rural ado-lescents’ substance use to community norms may be espe-cially relevant. Based on these data, rural adolescents areapparently just as amenable to substance misuse screeninginterventions in primary care as their urban peers. Thisstudy also found that rural teens are more likely to overes-timate the prevalence of substance abuse. This finding indi-rectly supports the use of personalized norm setting withrural adolescents. Although additional studies are needed toconfirm that personalized norm setting is an effective prac-tice with rural youth, there is no reason to believe thatpersonalized norm setting would not work with rural ado-lescent substance misusers. This study is limited in that

findings may not generalize to all rural areas, and a conve-