The need to teach medical students counseling skills for cardiovascular disease (CVD) risk factor modification is increasingly recognized as a priority for a curriculum in Preventive Cardiology. To meet this objective, we developed a clinical exercise using a group of high trained Patient Instructors (PIs) who fulfill the multiple roles of patient, evaluator, and teacher by (a) simulating a symptomatic ambulatory patient with a standardized case history that contains high risk profile for CVD due to the pressure of multiple risk factors; (b) objectively evaluating the performance of the students' counseling skills using a reliable and validated risk factor interview scale; and (c) providing corrective feedback following the doctor-patient encounter. The efficacy of this exercise, therefore, has been established with students at our own institution. We propose to conduct a prospective educational intervention trial in which this PI exercise will be transferred to six transferred to six medical schools that already display a commitment to preventive cardiology as evidence by their receipt of the Preventive Cardiology Academic Award from the NHLBI. Using our cadre of PIs, the intervention will be implemented during a four-day site visit as an additional instructional component of the curricula. Thirty-six students will be randomly sampled at each school (a total N of 216) and randomly assigned to one of three conditions: I. Interview followed by PI feedbacks; II. Interview followed by faculty group discussion; or II. Usual curriculum control. All students will be assessed six months following intervention. Two schools will participate in each of the first three project years. We predict that students who learn CVD risk factor counseling skills through feedback provided by the PI will display superior risk factor counseling skills, and that even conducting the standardized interview without explicit PI feedback will have a beneficial effect relative to the usual curriculum. Exploratory analyses will be performed to identify measures of student preparation or curriculum content that may be associated with counseling skill. The results of this educational experiment should provide more convincing evidence of the effectiveness of this training exercise for teaching medical students clinical skills in preventive cardiology and, thereby, encourage its more widespread dissemination.
