Evaluating the Global Rating scale's psychometric properties to assess communication skills of undergraduate medical students in video-recorded simulated patient encounters

Development of an instrument for medical students' self-assessment of facets of competence for patient-centred care

OBJECTIVE

To develop a facets of competence self-assessment instrument (FOCSI) with operationalised items for ten competence facets required for patient-centred care at the beginning of residency.

METHODS

We conducted focus groups and cognitive interviews with final-year medical students to develop items that match students' clinical experience. We tested 50 items in two samples and analysed model fit and internal consistency of all possible combinations to identify the optimal ten-item-solution. Item analysis was performed as well as correlation with six personality traits.

RESULTS

An optimal ten-item solution for the self-assessment instrument emerged for sample 1 (n = 101, 27.2 ± 3.5 years, 75.2 % female). We validated the model fit with sample 2 (n = 135, 27.7 ± 3.9 years, 66.7 % female): χ2(35) = 49.3, p = .055, CFI = .94, RMSEA = .055, SRMR = .058, Cronbach's alpha = .78. The personality factors 'Conscientiousness' and 'Extraversion' correlate positively with most FOCSI items.

CONCLUSION

The operationalised FOCSI items support undergraduate medical students close to graduation in realistic self-assessment of facets of competences for patient-centred care in their transition to residency.

PRACTICE IMPLICATIONS

Realistic self-assessment of facets of competence will provide medical students with the opportunity to monitor their competence development as part of self-directed learning for gaining adaptive expertise in professional, patient-centred care.

A blended learning for general practitioners and nurses on skills to support shared decision-making with patients about palliative cancer treatment: A one-group pre-posttest study

OBJECTIVE

To evaluate a newly developed blended learning programme for general practitioners (GPs) and nurses in supporting shared decision making (SDM) about palliative cancer treatment in a simulated setting.

METHODS

In a pre-posttest study, healthcare professionals (HCPs) participated in the blended learning (i.e. e-learning and (online) training session). HCPs filled out surveys (T0 (baseline), T1 (after e-learning) and T2 (after full blended learning)) and engaged in simulated consultations at T0 and T2. The primary outcome was observed SDM support (Triple-S; DSAT-10 for validation). Secondary outcomes included satisfaction, knowledge about and attitude towards SDM support. Repeated measures General Linear Models were conducted.

RESULTS

33 HCPs (17 GPs and 16 nurses) participated. SDM support significantly improved after training (Triple-S; medium effect). Observers' overall rating of SDM support (medium effect) as well as HCPs' knowledge (large effect) and beliefs about their capabilities (medium effect) improved after training. There was no difference in decision support skills (DSAT-10), HCPs' other clinical behavioural intentions and satisfaction. HCPs evaluated the training positively.

CONCLUSION

Blended learning for HCPs on supporting SDM in palliative cancer care improved their skills, knowledge and confidence in simulated consultations.

PRACTICE IMPLICATIONS

These first findings are promising for evaluating interprofessional SDM in clinical practice.

A simulation-based OSCE with case presentation and remote rating - development of a prototype

Simulation-based examination formats improve the possibility to assess medical students' competences during their performance. Additionally, videotaping of simulations allows for remote rating, providing advantages for raters, students, and exam organizers. We describe a simulation-based OSCE prototype with remote rating of students' competences, developed to replace a conventional OSCE at Hamburg Medical Faculty. The assessment consists of two phases: a consultation phase with four simulated patient encounters and a case presentation phase where four students present two cases each. All encounters from the consultation and the presentation phase are to be videotaped and remotely rated by clinical raters. Advanced medical students (year 4) are to be assessed regarding their clinical knowledge as well as physician-patient-communication, clinical reasoning competence, and patient management competence. We provide detailed schedules for the simulation-based OSCE procedure and a roster for organization. When piloting the assessment, we encountered two major obstacles with respect to legal obligations regarding examination time and videotaping which allowed us to provide tips on how to successfully implement this assessment prototype. Remote rating will, when successfully implemented, help students to concentrate on their consultation or presentation tasks, reduce raters' time constraints and also allow for randomized rating. Using established instruments for competence-rating rather than OSCE checklists provides an additional feature for this simulation-based OSCE prototype. Legal issues can be avoided by using the prototype for formative assessment but should be addressed in advance when it is planned to be used as summative assessment.