The importance of race in medical student performance of an AIDS risk assessment interview with simulated patients.

Abstract

This study was done to ascertain the effect of race on medical student-patient communication. The primary hypothesis was that interviewing performance scores would be higher when race of student and race of simulated patient instructor (SPI) were concordant than when they were discordant. Data obtained from student interactions with four Caucasian and four African American female SPIs participating in a case involving an AIDS risk assessment interview were analysed. Performance was assessed using two instruments: an 8-item behaviourally anchored interviewing skills scale and a 14-item checklist reflecting content relevant to sexual behaviour and AIDS risk. SPI groups were comparable and SPIs were trained to a high level of inter-rater reliability. Students (24 African American and 180 non-African American) were assigned to SPIs based on the spelling of the student's name. Performance was scored independently at the conclusion of each interview by both the SPI and the student her/himself. African American students had lower scale scores than non-African American students in interactions with Caucasian (but not African American) SPIs; and all student scores, both on the skills scale and the content checklist, were higher with African American than with Caucasian SPIs (as assessed by both SPI and student). Women students had higher scores than men. Race of SPI has an influence on student performance of an AIDS risk assessment interview. Further studies focusing on racial interactions in the medical interview are required. It appears that race of SPI may need to be accounted for in the development and interpretation of SPI-based clinical competence exams.