Journal of General Internal Medicine

, Volume 27, Issue 6, pp 700–707 | Cite as

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

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



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 behaviors medical education training standardized patients alcohol tobacco sexual health 



This work was supported by the National Institute on Drug Abuse (#K23 DA018691 and #P50 DA09253), the State of California Tobacco-Related Disease Research Program (#17RT-0077), and the National Institute of Mental Health (#R01 MH083684). We thank Jewel Smally and Ann Homan for overseeing the patient-actors and survey data collection; Patricia Donnellan, MPH, Rachel Grana, PhD, Norval Hickman, PhD, MPH, Romina Kim, and Nicholas Orozco for assisting with training the standardized patient actors; the standardized patient actors Chloe Bronzan, Audra Wolfman, and Linnea George-Kupfer; and Kevin Delucchi, PhD, for his consultation on statistical analyses.

Conflicts of Interest

None disclosed.


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Copyright information

© Society of General Internal Medicine 2011

Authors and Affiliations

  • Judith J. Prochaska
    • 1
    Email author
  • 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

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