Utilizing standardized patients (SPs), house staff knowledge of alcohol and substance abuse was assessed in residents just prior to their starting their first graduate year of training. A total of 345 residents from 13 different residencies in eight institutions participated in this program. Each resident was assigned four SP cases. The reliability of these encounters ranged from 0.63 to 0.74. Of the participating residents, 22% were United States medical graduates (USMGs) and 78% were international medical graduates (IMGs). A considerable proportion of both USMGs and IMGs failed to ask appropriate questions concerning alcohol and drug use or identify the presence of risk factors associated with such use. Residents' scores on cases primarily dealing with general medical issues, as compared to those dealing with substance abuse, were consistently higher. Knowledge of basic information concerning substance abuse and opioids was deficient in over 50% of those tested. These findings suggest that residents about to start their clinical training are not sufficiently prepared to address patients presenting with alcohol and other drug problems.
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