Background The National Institute for Health and Clinical Excellence recognises that times of transition, including adolescence, offer opportunities for intervention in health-related behaviour. Adolescence is characterised by the building of identity, independence and relationships, while navigating complex emotional and physical change. According to Public Health England, half of the most common health problems in adults arise from behaviours that are established during adolescence (Rise Above Programme, 2017). Smoking is a key example, with 40% of adult smokers in the UK starting smoking before the age of 16 years.
Aim To design an objective structure clinical examination (OSCE) station to assess the medical students’ communication skills to challenge unhealthy behaviours in which adolescent smokers play a central role from inception to final assessment.
Methods We initially developed a workshop with medical educators and adolescent smokers to identify which behaviours and attributes of doctors would facilitate their engagement with smoking cessation services. Together, we co-created the consultation narrative for a smoking cessation OSCE that assesses the ability of medical students to practice motivational interviewing, a behavioural change technique included and taught in their curriculum. This OSCE station was included in the summative assessment of 364 medical students in their penultimate year. We recruited trained examiners and adolescent actors (all of whom had to give written feedback to the candidates) as well as administrators specifically for this station.
Results Descriptive analyses of students’ OSCE marks demonstrated the feasibility of assessing and giving feedback on different elements of students’ motivational interview skills, with substantial agreement between the examiners’ and role-players’ scores. Most students (85%) were successful in providing structure to the consultation and building rapport with adolescent role-players. However, only 50% of students sufficiently explored the young person’s life circumstances and tailored the management plan and practical advice to the individual. Adopting a personalised consultation approach was identified by adolescents as a crucial factor in supporting their autonomy and improving their engagement with smoking cessation services.
Conclusion Adolescents can be key partners in improving medical education to shape the attributes of new doctors and increase the relevance of assessments to real-life clinical practice.
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