Journal of General Internal Medicine

, Volume 27, Issue 6, pp 700–707

Medical Students’ Attention to Multiple Risk Behaviors: A Standardized Patient Examination

  • Judith J. Prochaska
  • Kathleen Gali
  • Bernie Miller
  • Karen E. Hauer
Original Research

DOI: 10.1007/s11606-011-1953-9

Cite this article as:
Prochaska, J.J., Gali, K., Miller, B. et al. J GEN INTERN MED (2012) 27: 700. doi:10.1007/s11606-011-1953-9



Risk behaviors tend to cluster, particularly among smokers, with negative health effects. To optimize patients’ health and wellbeing, health care providers ideally would assess and intervene upon the multiple risks with which patients may present.


This study examined medical students’ skills in assessing and treating multiple risk behaviors.


Using a randomized experimental design, medical students’ counseling interactions were evaluated with a standardized patient presenting with sexual health concerns and current tobacco use with varied problematic drinking status (alcohol-positive or alcohol-negative).


One hundred and fifty-six third-year medical students.


Student and standardized patient completed measures evaluated student knowledge, attitudes, and clinical performance.


Overall, most students assessed tobacco use (85%); fewer assessed alcohol use (54%). Relative to the alcohol-negative case, students seeing the alcohol-positive case were less likely to assess sexually transmitted disease history (80% vs. 91%, p = 0.042), or patients’ readiness to quit smoking (41% vs. 60%, p = 0.025), and endorsed greater attitudinal barriers to tobacco treatment (p = 0.030). Patient satisfaction was significantly lower for the alcohol-positive than the alcohol-negative case; clinical performance ratings moderated this relationship.


When presented with a case of multiple risks, medical students performed less effectively and received lower patient satisfaction ratings. Findings were moderated by students’ overall clinical performance. Paradigm shifts are needed in medical education that emphasize assessment of multiple risks, new models of conceptualizing behavior change as a generalized process, and treatment of the whole patient for optimizing health outcomes.


multiple risk behaviorsmedical educationtrainingstandardized patientsalcoholtobaccosexual health

Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Judith J. Prochaska
    • 1
  • Kathleen Gali
    • 1
  • Bernie Miller
    • 2
  • Karen E. Hauer
    • 2
  1. 1.Department of PsychiatryUniversity of CaliforniaSan FranciscoUSA
  2. 2.Department of MedicineUniversity of CaliforniaSan FranciscoUSA