Assessing the development of communication skills in undergraduate medical students

Assessment of Communication Skills in MBBS Interns with Objective Structured Video Examination (OSVE)

Background

Medical graduates enter work force with substantial knowledge but are they prepared for practice in diverse settings? To train medical interns in communication skills using Demonstration Observation Assistance and Performance (DOAP) and to assess communication skills in medical interns using objective structured video examination (OSVE).

Methods and Materials

DOAP sessions of all 27 interns posted in Community Medicine and Pediatrics departments during the duration of the study were conducted in six clinical scenarios followed by two OSVEs.

Methods and Material

Interns performed selected activity independently twice for assessments. Videos submitted by interns were assessed by Gap Kalamazoo assessment forms (OSVE). Data analysis was done by appropriate methods. Percentages and proportions and calculation of median scores with interquartile ranges.

Results

Seventy one point four percent of faculty and 96.3% of interns were satisfied with module implementation. More than = 57.8% marks were scored by 94.45% interns in self-assessment and faculty assessment and by 100% interns in patient assessment. Median scores of all second assessments were higher.

Conclusions

DOAP method is good for training of interns in communication skills. OSVE may be an appropriate assessment tool as it leads to progression in learning.

The role of the emotive, moral, and cognitive components for the prediction of medical students' empathic behavior in an Objective Structured Clinical Examination (OSCE)

OBJECTIVES

Investigate whether medical students' emotive abilities, attitudes, and cognitive empathic professional abilities predict empathic behavior in an Objective Structured Clinical Examination (OSCE).

METHODS

Linear and multiple regressions were used to test concurrent validity between Interpersonal Reactivity Index (IRI), Jefferson Scale of Physician Empathy (JSPE-S), Situational Judgement Test (SJT-expert-based score (SJT-ES), SJT-theory-based score (SJT-TS)) and empathic behavior in an OSCE measured by Berlin Global Rating (BGR) and Verona Coding Definitions for Emotion Sequences (VR-CoDES).

RESULTS

Highest amounts of explained variance of empathic behavior measured by VR-CoDES were found for the SJT-ES (R2 = 0.125) and SJT-TS (R2 = 0.131). JSPE-S (R2 = 0.11) and SJT-ES (R2 = 0.10) explained the highest amount of variance in empathic behavior as measured by BGR. Stepwise multiple regression improved the model for BGR by including SJT-ES and JSPE-S, explaining 16.2% of variance.

CONCLUSIONS

The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small.

PRACTICE IMPLICATIONS

The instrument measuring the emotive component (IRI) did not significantly predict empathic behavior, whereas instruments measuring moral (JSPE-S) and cognitive components (SJT) significantly predicted empathic behavior. However, the explained variance was small. In a longitudinal assessment program, triangulation of different instruments assessing empathy offers a rich perspective of learner's empathic abilities. Empathy training should include the acquisition of knowledge, attitudes, and behavior to support learner's empathic behaviors.

Are different medical school admission tests associated with the outcomes of a simulation-based OSCE?

BACKGROUND

Medical school admission procedures have the common goal to select applicants with the greatest potential of becoming successful physicians. Hamburg Medical Faculty selects medical students by grade point average (GPA) and employs a two-step selection process of a natural sciences test (HAM-Nat), in some cases followed by multiple mini-interviews (HAM-Int). Multiple mini-interviews can predict non-cognitive outcomes, while GPA has predictive validity for cognitive outcomes. The aim of our study was to explore communication skills and clinical knowledge of advanced medical students according to their respective admission procedure.

METHODS

In July 2019, 146 students grouped according to their admission procedure into GPA-only (19.2 %), HAM-Nat (33.6 %), HAM-Int (30.8 %), and Waiting List (16.4 %) participated in four OSCE stations which equally assessed students' communication skills (OSCE part 1) and clinical knowledge (OSCE part 2) in simulated patient encounters, rated by physicians with checklists. Additionally, psychosocial assessors ranked communication skills with a global rating scale (GR). The students also participated in a multiple choice (MC) exam testing clinical knowledge. Kruskal-Wallis analyses of variance of test performance and Spearman correlation of instruments were calculated.

RESULTS

Students from the Waiting List group performed significantly worse on the MC exam compared to GPA-only and HAM-Int (adjusted p = .029 and 0.018, respectively). No significant differences were found between the admission groups with respect to communication skills. Global Rating and OSCE part 1 (communication) correlated significantly (ρ = 0.228, p = .006) as did OSCE part 2 (clinical knowledge) and MC exam (ρ = 0.242, p = .003), indicating criterion validity. Constructs did not overlap, indicating divergent validity.

CONCLUSIONS

Advanced medical students selected for undergraduate studies by multiple mini-interviews assessing psychosocial skills showed similar communication skills compared to students admitted to medical school by other entryways. It is unclear whether these similarities are due to an effective undergraduate longitudinal communication curriculum. Assessing baseline communication skills of all medical students at entry-level may aid with this question.

Structure and Content of a New Entrance Exam to Select Undergraduate Nursing Students

Aim The aim of this study was to develop an evidence-based structure and content for the new nursing entrance examination. Background The purpose of the student selection process is to ensure that those admitted have the required aptitude, motivation and potential to successfully complete studies. Methods The literature reviews were collected using systematic searches in five electronic databases on the assessment of learning skills, social skills/ emotional intelligence and certainty of career choice of nursing applicants. Three focus group interviews (n = 26) were conducted. Data were analysed inductively. The structure and content of the entrance examination was formed by two data sets synthesis. Findings Nursing student selection should involve the assessment of five categories in learning skills, three in social skills and four categories in certainty of career choice. Conclusion Comprehensive assessment can ensure that those admitted are suitable for the profession and have the capability to succeed in their studies.

The art of talking about science: beginning to teach physiology students how to communicate with nonscientists

The ability to clearly disseminate scientific knowledge is a skill that is necessary for any undergraduate student within the sciences. Traditionally, this is accomplished through the instruction of scientific presentation or writing with a focus on peer-to-peer communication at the expense of teaching communication aimed at a nonscientific audience. One of the ramifications of focusing on peer-to-peer communication has presented itself as an apprehension toward scientific knowledge within the general populace. This apprehension can be seen in a variety of venues, including the traditional media, popular culture, and education, which generally paint scientists as aloof and with an inability to discuss scientific issues to anyone other than other scientists. This paper describes a curriculum designed to teach Introduction to Anatomy and Physiology students the tools necessary for communicating complex concepts that were covered during the semester using approachable language. Students were assessed on their word usage in associated writing activities, the student's ability to reduce complexity of their statements, and performance in an informal scientific presentation to a lay audience. Results showed that this pedagogical approach has increased students' ability to reduce the complexity of their language in both a written and oral format. This, in turn, led to evaluators reporting greater levels of understanding of the topic presented following the presentation.

Psychodynamic approaches to teaching medical students about the doctor–patient relationship: randomised controlled trial

Aims and method

To evaluate the effectiveness of two psychodynamic psychotherapy teaching methods, a student psychotherapy scheme (SPS) and participation in a Balint group, in teaching first-year clinical medical students about doctor–patient communication and the doctor–patient relationship. The 28 students, who were randomly allocated to three groups (SPS group, Balint group starting at baseline and Balint group starting at 3 months and acting as partial controls), were rated on a questionnaire testing their knowledge of emotional and psychodynamic aspects of the doctor–patient relationship administered at baseline, at 3 months and at 1 year.

Results

At 3 months, students in the SPS and Balint groups scored higher than the partial control group, the difference approaching significance at the 5% level. At 1 year, participation in either teaching method led to significantly higher scores compared with baseline.

Clinical implications

Psychodynamic psychotherapy teaching methods are effective in increasing students' knowledge of the doctor-patient relationship and potentially also improving their communication skills.

Attachment styles and clinical communication performance in trainee doctors

OBJECTIVE

To investigate the relationship between trainee doctors' attachment style and their performance in qualifying clinical and communication skills assessments.

METHODS

Participants were 190 undergraduate medical students whose performance was assessed by examiners across two areas (communication and clinical skills) during their qualifying Objective Structured Clinical Examination (OSCE). Simulated patients also rated communication skills. Participants' attachment style was rated across two dimensions, avoidance and anxiety, using the Relationship Questionnaire (RQ).

RESULTS

Lower levels of attachment avoidance and anxiety significantly predicted higher performance in both communication and clinical skills.

CONCLUSION

Trainee doctors' attachment styles are associated with patient communication and clinical performance. Further research is needed to investigate the impact of attachment on consultations between doctors and patients within clinical settings.

PRACTICE IMPLICATION

Attachment theory can inform our understanding why, for some student doctors, interacting with patients may be particularly challenging and require additional support by medical educators.

Communication skills in medical students - An exploratory study before and after clerkships

INTRODUCTION

Effective communication is the cornerstone of a fruitful patient-physician relationship. Teaching clinical communication has become a pivotal goal in medical education. However, approaches measuring the maintenance of learned skills are needed since a decline in some communication skills during medical school has been reported.

OBJECTIVE

Explore medical students' communication skills in a simulated clinical encounter before and after clerkships.

METHODS

Two-hundred-fifty-five undergraduate students attending the second year of medical course, at the Faculty of Medicine of University of Porto, completed a 1.5-h per week course over 4 months on basic communication skills. The students' final evaluation consisted in an interview with a simulated patient, assessed by a teacher using a standardized framework. Three years later, while attending clerkships, 68 students from the same population completed a re-evaluation interview following the same procedure.

RESULTS

Medical students maintained a communication skill mean level similar to that of the original post-training evaluation, but significant differences in specific communication abilities were detected in this group of students. Empathic attitudes and ability to collect information improved whereas interview structure and non-verbal behavior showed a decline during clerkships expressing a balance between the competencies that improved, those that declined, and those that remained unchanged.

CONCLUSION

Present findings emphasize the importance of patient contact, context and clinical role models on the maintenance of learned skills, underscoring the importance of an integrated approach of clinical communication teaching throughout medical school.

Has the inclusion of a longitudinally integrated communication skills program improved consultation skills in medical students? A pilot study

Background:

Evidence highlights a lack of communication skills in doctors leading to dysfunctional consultations. To address this deficit, a private medical college instituted curricular reforms with inclusion of a longitudinal communication skills program. A pilot study was undertaken to evaluate the effectiveness of this program by comparing the consultation skills of medical students of this college with a medical college without a communication skills program.

Methods:

A 4-station Objective Structured Clinical Examination (OSCE) was conducted in the third and final year. Mann–Whitney U-test was used to compare the difference in the distribution between OSCE stations total and construct scores.

Results:

At the end of the third year, 21 (31.34%), students of the study site (medical college 1 [college with integrated longitudinal communication skills program]) and 31 (46.26%) students from the comparison site (medical college 2 [comparable college without communication skills program]) consented. Medical college 1 achieved a significantly higher overall mean total station score of 68.0% (standard deviation [SD] =13.5) versus 57.2% (SD = 15.4) (P < 0.001). Significantly higher mean scores were achieved on three stations. At the end of the final year, 19 students (29.3%) from medical college 1 and 22 (34%) students from medical college 2 consented. The difference in overall mean total station score reduced from 9.2% to 7.1% (70.2) (SD = 13.7) versus 63.1 (SD = 15.2) (P = 0.004). The mean scores of both colleges decreased in “Patient presenting with Hepatitis C Report” station (P values 0.004 and 0.775) and in “Patient Request for Faith Healing Therapy in Diabetes Mellitus” station (P values 0.0046 and 0.036), respectively.

Conclusion:

Longitudinal communication skills in an undergraduate curriculum positively impacted consultation skills. Community-based training and faculty development are required to develop effective patient-centered consultation skills.

Well, you have hepatic metastases: Use of technical language by medical students in simulated patient interviews

OBJECTIVE

This research explored medical students' use and perception of technical language in a practical training setting to enhance skills in breaking bad news in oncology.

METHODS

Terms potentially confusing to laypeople were selected from 108 videotaped interviews conducted in an undergraduate Communication Skills Training. A subset of these terms was included in a questionnaire completed by students (N=111) with the aim of gaining insight into their perceptions of different speech registers and of patient understanding. Excerpts of interviews were analyzed qualitatively to investigate students' communication strategies with respect to these technical terms.

RESULTS

Fewer than half of the terms were clarified. Students checked for simulated patients' understanding of the terms palliative and metastasis/to metastasize in 22-23% of the interviews. The term ambulatory was spontaneously explained in 75% of the interviews, hepatic and metastasis/to metastasize in 22-24%. Most provided explanations were in plain language; metastasis/to metastasize and ganglion/ganglionic were among terms most frequently explained in technical language.

CONCLUSION

A significant number of terms potentially unfamiliar and confusing to patients remained unclarified in training interviews conducted by senior medical students, even when they perceived the terms as technical.

PRACTICE IMPLICATIONS

This exploration may offer important insights for improving future physicians' skills.

Communication skills training in medical students: do motivational orientations predict changes over time in psychosocial attributes?

Perceived psychosocial abilities (i.e., competence in addressing the psychosocial aspects of patient care) and low frustration tolerance (LFT) (i.e., intolerance of physical or emotional discomfort) have been established as significant attributes of experienced medical professionals. We aimed to expand our understanding of the role motivation plays within communication skills training by investigating whether motivation precedes or, conversely, follows psychosocial attributes. According to goal orientations theory, motivation denotes the goals students pursue when engaging in learning tasks. We hypothesized that goal orientations would predict development of psychosocial attributes. More specifically, an adaptive goal orientation (i.e., mastery goal orientation) was expected to predict perceived psychosocial abilities, whereas the maladaptive goal orientations (i.e., performance-approach and avoidance goal orientations) were hypothesized to predict LFT (frustration intolerance). The study spanned two sequential years, in which two cohorts of first-year medical students (N = 151) completed questionnaires at the beginning and end of an annual physician-patient communication course. The questionnaires assessed goal orientations, perceived psychosocial abilities, and LFT. Cross-lagged analyses using Structural Equation Modeling indicated that goal orientations significantly predicted perceived psychosocial abilities, as hypothesized; however, LFT predicted maladaptive goal orientation, rather than the other way around. These findings provided further support for the contribution of goal orientations theory within medical education contexts. Medical schools are advised to consider motivational aspects when planning and implementing training programs.

National survey of clinical communication assessment in medical education in the United Kingdom (UK)

BACKGROUND

All medical schools in the UK are required to be able to provide evidence of competence in clinical communication in their graduates. This is usually provided by summative assessment of clinical communication, but there is considerable variation in how this is carried out. This study aimed to gain insight into the current assessment of clinical communication in UK medical schools.

METHODS

The survey was sent via e-mail to communication leads who then were asked to consult with all staff within their medical school involved in the assessment of communication.

RESULTS

Results were obtained from 27 out of 33 schools (response rate 82%) and a total of 34 courses. The average number of assessments per year was 2.4 (minimum 0, maximum 10). The Objective Structured Clinical Exam (OSCE) was the most commonly used method of assessment (53%). Other assessments included MCQ and workplace based assessments. Only nine courses used a single method of assessment. Issues raised included, logistics and costs of assessing mainly by OSCE, the robustness and reliability of such exams and integration with other clinical skills.

CONCLUSIONS

It is encouraging that a variety of assessment methods are being used within UK medical schools and that these methods target different components of clinical communication skills acquisition.

The influence of medical students' and doctors' attachment style and emotional intelligence on their patient-provider communication

OBJECTIVE

Attachment style and emotional intelligence (EI) have been highlighted as potential factors influencing the variation in medical students' and doctors' patient-provider communication (PPC), particularly in relation to emotive issues. The objective of this review is to systematically review and synthesise the published literature relating to the influence of medical students' and/or doctors' attachment style and EI on their PPC.

METHODS

Electronic and hand searches were conducted to identify all published literature relating to the aim of the review. Data were narratively synthesised.

RESULTS

1597 studies were identified. 14 were included in the review, of which 5 assessed the influence of attachment style and 9 assessed the influence of EI on PPC. No studies assessed the impact of both attachment style and EI on PPC.

CONCLUSION

Whilst tentative links were found between both PPC and both attachment style and EI, heterogeneity in study design, predictor variables and outcome measures made drawing conclusions difficult.

PRACTICE IMPLICATIONS

More research is needed to assess the influence of both attachment style and EI on PPC.

Connecting with different audiences: the anatomy of communication is essential

In the twenty-first century, communication has become truly global. Advances in technology have opened up a host of ways in which we are able to communicate to retrieve or pass on information and knowledge. In many cases we have moved from a place-based communication approach to one of increasing mobility. With this shift in approach, it is apparent that effective communication skills are perhaps even more important so that we can connect appropriately with diverse audiences. Despite this, relatively little attention has been paid to training our students in different modes of communication and therefore we may not be fully preparing our students to play their part in the global community. Given anatomy's place within many health-care curricula, an ideal avenue is available for anatomists to take the lead in providing communications skills training for students. There are a variety of approaches, some of which are outlined in this article, which can be used to create appropriate opportunities for developing different communication skills and these can be woven into existing practices to ensure courses do not become overburdened. A sustained approach to communication skills training will help equip our students to communicate easily with the many aspects of modern society.

Assessing medical student competency in communication in the pre-clinical phase: objective structured video exam and SP exam

OBJECTIVE

The aim of our study was to present the structure, process and results of the objective structured video exam and One-Station standardized patient exam that have been used to assess second year medical students' communication skills.

METHODS

Scores of 1137 students between the years 2007 and 2010 were analyzed. Means and standard deviations were calculated for scores and ratings. Internal consistency was assessed using Cronbach's alpha coefficient. To analyze reliability and generalizability, multivariate generalizability theory was employed.

RESULTS

Students' total and item scores on the objective structured video exam (60.5-68.8) were lower than on the One-Station standardized patient exam (90.4-96.6). Internal consistencies of both exams were moderate. Generalizability analysis and D-study results showed that both the objective structured video exam and the One-Station standardized patient exam need improvement.

CONCLUSION

Both exams need measures to improve them, such as increasing the number of video cases or stations, and further standardization of raters.

PRACTICE IMPLICATIONS

This study might encourage medical teachers to consider assessing validity and reliability of written and performance exams on the basis of generalizability theory, and to find out feasible actions to improve assessment procedures by conducting a D-study.

Enhancing medical students' communication skills: development and evaluation of an undergraduate training program

BACKGROUND

There is a relative lack of current research on the effects of specific communication training offered at the beginning of the medical degree program. The newly developed communication training "Basics and Practice in Communication Skills" was pilot tested in 2008 and expanded in the following year at the University Medical Centre Hamburg-Eppendorf in Germany. The goal was to promote and improve the communicative skills of participants and show the usefulness of an early offered intervention on patient-physician communication within the medical curriculum.

METHODS

The students participating in the project and a comparison group of students from the standard degree program were surveyed at the beginning and end of the courses. The survey consisted of a self-assessment of their skills as well as a standardised expert rating and an evaluation of the modules by means of a questionnaire.

RESULTS

Students who attended the communication skills course exhibited a considerable increase of communication skills in this newly developed training. It was also observed that students in the intervention group had a greater degree of self-assessed competence following training than the medical students in the comparison group. This finding is also reflected in the results from a standardised objective measure.

CONCLUSIONS

The empirical results of the study showed that the training enabled students to acquire specialised competence in communication through the course of a newly developed training program. These findings will be used to establish new communication training at the University Medical Centre Hamburg-Eppendorf.

Pilot evaluation of a biopsychosocial integrated standardized patient examination in a family medicine clerkship

OBJECTIVE

A new biopsychosocial Integrated Standardized Patient Examination (ISPE) was implemented to assess communication skills for medical students participating in a family medicine clerkship.

METHOD

Mixed method, multi-level evaluation.

RESULTS

Pilot ISPE scores were significantly higher than previous Objective Structured Clinical Examination (OSCE) (p < .01). Family Physician and Social/Behavioral Scientist rater scores were correlated (p < .001), and Cronbach's alpha statistics were acceptable (FM: alpha = .837; BH: alpha = .768). Preceptor scores on "relations with professionals" (beta = .694, p = .008) significantly predicted ISPE scores, but other clerkship assignment grades were inversely associated with ISPE. Qualitative focus group themes included lack of readiness, divergence in beliefs on scope of physician practice, and focus on grade.

CONCLUSIONS

This pilot project describes the process and demonstrates the possibility of implementing a complex standardized patient case to assess students' management of complicated primary care patients with medical, psychological, and social issues.

Using an objective structured video exam to identify differential understanding of aspects of communication skills

BACKGROUND

Effective communication in health care is associated with patient satisfaction and improved clinical outcomes. Professional schools increasingly incorporate communication training into their curricula. The objective structured video exam (OSVE) is a video-based examination that provides an economical way of assessing students' knowledge of communication skills. This study presents a scoring strategy that enables blueprinting of an OSVE to consensus guidelines, to determine which aspects of communication skills create the most difficulty for students to understand and to what degree understanding improves through experiential communication skills training.

METHODS

Five interactions between a healthcare professional and client were scripted and filmed using standardized patients. The dialogues were mapped onto the Kalamazoo consensus statement by having five communication experts view each video and identify effective and ineffective use of communication skills. Undergraduate students enrolled in a communications course completed an OSVE on three occasions.

RESULTS

A total of 79 students completed at least one testing session. The scores assigned supported the validity of the scoring strategy as an indication of knowledge growth. Considerable variability was observed across Kalamazoo sub-domains.

CONCLUSION

With further refining, this scoring approach may prove useful for educators to tailor their education and assessment practices to specific consensus guidelines.

The communication competency of medical students, residents and consultants

OBJECTIVE

The model of expert performance predicts that neither physicians in training nor experienced physicians will reach an expert level in communication. This study tested this hypothesis.

METHODS

Seventy-one students, twenty-five residents and fourteen consultants performed a 'breaking bad news' exercise with a simulated patient. Their communication competency was assessed with the CELI instrument. Actor assessments were also obtained. The differences in communication competency between students, residents and consultants were established.

RESULTS

The mean performance scores ranged from bad to adequate. An expert level of performance was seldom reached. Novice students scored lower than the other groups in their competency and in the actor assessment. First-year students scored lower than the consultants in their competency and in the actor assessment. No differences in performance were found between third-year students, interns, residents and consultants.

CONCLUSION

Students acquire a 'satisfactory' level of communication competency early in the curriculum. Communication courses in the curriculum do not enhance this level. Clinical experience has also a limited effect.

PRACTICE IMPLICATIONS

The learning conditions for deliberate practice must be fulfilled in medical curricula and in postgraduate training in order to provide medical students and physicians the opportunity to attain an expert level in communication.

The feasibility of a multi-format Web-based assessment of physicians' communication skills

OBJECTIVE

Little is known about the best approaches and format for measuring physicians' communication skills in an online environment. This study examines the reliability and validity of scores from two Web-based communication skill assessment formats.

METHODS

We created two online communication skill assessment formats: (a) MCQ (multiple-choice questions) consisting of video-based multiple-choice questions; (b) multi-format including video-based multiple-choice questions with rationales, Likert-type scales, and free text responses of what physicians would say to a patient. We randomized 100 general internists to each test format. Peer and patient ratings collected via the American Board of Internal Medicine (ABIM) served as validity sources.

RESULTS

Seventy-seven internists completed the tests (MCQ: 38; multi-format: 39). The adjusted reliability was 0.74 for both formats. Excellent communicators, as based on their peer and patient ratings, performed slightly better on both tests than adequate communicators, though this difference was not statistically significant. Physicians in both groups rated test format innovative (4.2 out of 5.0).

CONCLUSION

The acceptable reliability and participants' overall positive experiences point to the value of ongoing research into rigorous Web-based communication skills assessment.

PRACTICE IMPLICATIONS

With efficient and reliable scoring, the Web offers an important way to measure and potentially enhance physicians' communication skills.

Cross-sectional evaluation of a longitudinal consultation skills course at a new UK medical school

BACKGROUND

Good communication is a crucial element of good clinical care, and it is important to provide appropriate consultation skills teaching in undergraduate medical training to ensure that doctors have the necessary skills to communicate effectively with patients and other key stakeholders. This article aims to provide research evidence of the acceptability of a longitudinal consultation skills strand in an undergraduate medical course, as assessed by a cross-sectional evaluation of students' perceptions of their teaching and learning experiences.

METHODS

A structured questionnaire was used to collect student views. The questionnaire comprised two parts: 16 closed questions to evaluate content and process of teaching and 5 open-ended questions. Questionnaires were completed at the end of each consultation skills session across all year groups during the 2006-7 academic year (5 sessions in Year 1, 3 in Year 2, 3 in Year 3, 10 in Year 4 and 10 in Year 5). 2519 questionnaires were returned in total.

RESULTS

Students rated Tutor Facilitation most favourably, followed by Teaching, then Practice & Feedback, with suitability of the Rooms being most poorly rated. All years listed the following as important aspects they had learnt during the session: • how to structure the consultation • importance of patient-centredness • aspects of professionalism (including recognising own limits, being prepared, generally acting professionally). All years also noted that the sessions had increased their confidence, particularly through practice.

CONCLUSIONS

Our results suggest that a longitudinal and integrated approach to teaching consultation skills using a well structured model such as Calgary-Cambridge, facilitates and consolidates learning of desired process skills, increases student confidence, encourages integration of process and content, and reinforces appreciation of patient-centredness and professionalism.

GULiVER--travelling into the heart of good doctor-patient communication from a patient perspective: study protocol of an international multicentre study

BACKGROUND

The project GULiVer explores how lay people in Belgium (Gent), the Netherlands (Utrecht), the UK (Liverpool) and Italy (Verona) evaluate physicians' communicative skills. The aims are to present the study design and to assess the quality of collected data.

METHODS

In each centre one out of two sets of four videotaped consultations involving medical students with varying communication skills were shown to eight lay panels of six to nine participants each (n = 259). The selection of lay participants was stratified by gender and age in order to obtain a heterogeneous sample. Background characteristics included socio-demographics, participants' general physical (COOP-WONCA) and mental health (GHQ), communication preferences (QUOTE-com) and trust in doctors (TMP). Participants were asked to give quantitative and qualitative evaluations of the student doctors' performance in a mixed-methods design. Quality assessment of the collected data and protocol adherence of the four centres was carried out by Generalized Linear Model (GLM).

RESULTS

The overall sample comprised 259 participants. Participants were equally distributed among the centres and balanced in terms of age, gender and OSCE scenario, confirming the quality of collected data.

CONCLUSION

The study design and the applied procedures will ensure a great richness of data allowing a wider European perspective on lay persons' views, assessed both individually and through focus group discussion.

Systematic development of a communication skills training course for physicians performing work disability assessments: from evidence to practice

BACKGROUND

Physicians require specific communication skills, because the face-to-face contact with their patients is an important source of information. Although physicians who perform work disability assessments attend some communication-related training courses during their professional education, no specialised and evidence-based communication skills training course is available for them. Therefore, the objectives of this study were: 1) to systematically develop a training course aimed at improving the communication skills of physicians during work disability assessment interviews with disability claimants, and 2) to plan an evaluation of the training course.

METHODS

A physician-tailored communication skills training course was developed, according to the six steps of the Intervention Mapping protocol. Data were collected from questionnaire studies among physicians and claimants, a focus group study among physicians, a systematic review of the literature, and meetings with various experts. Determinants and performance objectives were formulated. A concept version of the training course was discussed with several experts before the final training course programme was established. The evaluation plan was developed by consulting experts, social insurance physicians, researchers, and policy-makers, and discussing with them the options for evaluation.

RESULTS

A two-day post-graduate communication skills training course was developed, aimed at improving professional communication during work disability assessment interviews. Special focus was on active teaching strategies, such as practising the skills in role-play. An adoption and implementation plan was formulated, in which the infrastructure of the educational department of the institute that employs the physicians was utilised. Improvement in the skills and knowledge of the physicians who will participate in the training course will be evaluated in a randomised controlled trial.

CONCLUSIONS

The feasibility and practical relevance of the communication skills training course that was developed seem promising. Such a course may be relevant for physicians in many countries who perform work disability assessments. The development of the first training course of this type represents an important advancement in this field.

A web-based team-oriented medical error communication assessment tool: development, preliminary reliability, validity, and user ratings

BACKGROUND

Multiple-choice exams are not well suited for assessing communication skills. Standardized patient assessments are costly and patient and peer assessments are often biased. Web-based assessment using video content offers the possibility of reliable, valid, and cost-efficient means for measuring complex communication skills, including interprofessional communication.

DESCRIPTION

We report development of the Web-based Team-Oriented Medical Error Communication Assessment Tool, which uses videotaped cases for assessing skills in error disclosure and team communication. Steps in development included (a) defining communication behaviors, (b) creating scenarios, (c) developing scripts, (d) filming video with professional actors, and (e) writing assessment questions targeting team communication during planning and error disclosure.

EVALUATION

Using valid data from 78 participants in the intervention group, coefficient alpha estimates of internal consistency were calculated based on the Likert-scale questions and ranged from α=.79 to α=.89 for each set of 7 Likert-type discussion/planning items and from α=.70 to α=.86 for each set of 8 Likert-type disclosure items. The preliminary test-retest Pearson correlation based on the scores of the intervention group was r=.59 for discussion/planning and r=.25 for error disclosure sections, respectively. Content validity was established through reliance on empirically driven published principles of effective disclosure as well as integration of expert views across all aspects of the development process. In addition, data from 122 medicine and surgical physicians and nurses showed high ratings for video quality (4.3 of 5.0), acting (4.3), and case content (4.5).

CONCLUSIONS

Web assessment of communication skills appears promising. Physicians and nurses across specialties respond favorably to the tool.

Comparing narrative and multiple-choice formats in online communication skill assessment

OBJECTIVES

We compared multiple-choice and open-ended responses collected from a web-based tool designated 'Case for Change', which had been developed for assessing and teaching medical students in the skills involved in integrating sexual risk assessment and behaviour change discussions into patient-centred primary care visits.

METHODS

A total of 111 Year 3 students completed the web-based tool. A series of videos from one patient encounter illustrated how a clinician uses patient-centred communication and health behaviour change skills while caring for a patient presenting with a urinary tract infection. Each video clip was followed by a request for students to respond in two ways to the question: 'What would you do next?' Firstly, students typed their statements of what they would say to the patient. Secondly, students selected from a multiple-choice list the statements that most closely resembled their free text entries. These two modes of students' answers were analysed and compared.

RESULTS

When articulating what they would say to the patient in a narrative format, students frequently used doctor-centred approaches that focused on premature diagnostic questioning or neglected to elicit patient perspectives. Despite the instruction to select a matching statement from the multiple-choice list, students tended to choose the most exemplary patient-centred statement, which was contrary to the doctor-centred approaches reflected in their narrative responses.

CONCLUSIONS

Open-ended questions facilitate in-depth understanding of students' educational needs, although the scoring of narrative responses is time-consuming. Multiple-choice questions allow efficient scoring and individualised feedback associated with question items but do not fully elicit students' thought processes.

Ensino de massoterapia: habilidades envolvidas na relação fisioterapeuta-paciente

Desenvolvido no âmbito da disciplina Recursos Terapêuticos Manuais, o objetivo deste trabalho foi elaborar, aplicar e avaliar a eficácia de um programa de treinamento de habilidades profissionalizantes em sessão de massoterapia, com foco na relação fisioterapeuta-paciente, sem descuidar do autocuidado do terapeuta. Para elaboração do programa, foram identificadas 21 habilidades envolvidas nessa relação, com base na literatura e na observação de 120 sessões de massoterapia. Dez peritos validaram a definição operacional das habilidades, que foram organizadas em um programa de treinamento aplicado a alunos. O desempenho destes nas habilidades treinadas (classificado como adequado, parcialmente adequado, inadequado ou não-realizado) foi avaliado em prova prática. Também foi analisado relato escrito dos alunos sobre o programa. Participaram do estudo 25 graduandos. A análise dos resultados mostrou que todos realizaram 12 das 21 habilidades treinadas adequadamente. Quatro habilidades foram realizadas de forma parcialmente adequada por cinco alunos. Não ocorreu situação de execução inadequada. Na análise dos relatos, 19 dos 25 alunos afirmaram ser o treinamento importante e necessário. O autocuidado físico foi destacado como importante para o desenvolvimento profissional e apropriado para o contexto de ensino por dez alunos. O programa mostrou-se pois eficiente em capacitar os alunos para um bom relacionamento terapeuta-paciente, sendo bem aceito pelos alunos.

Cognitive expertise, emotional development, and reflective capacity: clinical skills for improved pain care

The overarching goal of medical training is to nurture the growth of knowledgeable, caring, and insightful clinicians guided by the ideals of medical professionalism. Recent definitions of professional competence identify essential clinical skills, including cognitive expertise, emotional competence, and reflective capacity. This modern framework reflects the increasingly complex nature of the patient-clinician interaction, in which the clinician must exchange diagnostic information while supportively engaging the patient on a deeper, affective level. The affective dimension can be particularly potent when pain is the primary symptom, as it is for the majority of medical visits. Unfortunately, however, current models of professionalism, used as an early guide for medical trainees to develop an understanding of the clinical exchange, largely focus on interactions in the cognitive domain. To emphasize the importance of emotions in professional development, we propose the Cognitive and Emotional Preparedness Model, which describes the clinical encounter occurring on two channels, one cognitive and the other emotional, and stresses the importance of multidimensional development in preparing the clinician to (1) communicate clinical information, (2) provide emotional support, and (3) actively reflect on experiences for continued improvement. Together, acquisition of knowledge, emotional development, and reflective skill will improve the clinical interaction.

PERSPECTIVE

The proficiency of medical trainees in developing clinical skills profoundly shapes patient satisfaction and treatment outcomes. This article reviews the cognitive, emotional, and reflective development of medical trainees and presents a model illustrating how clinical development impacts pain care. For improved efficacy, pain education should be calibrated to students' developmental needs.

Medical Student Attitudes Toward Communication Skills Training and Knowledge of Appropriate Provider-Patient Communication: A Comparison of First-Year and Fourth-Year Medical Students

Drawing upon Bloom's taxonomy of educational objectives as a theoretical framework, this study examines attitudes toward communication skills training, knowledge of appropriate provider-patient communication, and confidence communicating with patients between first-year and fourth-year medical students at a large medical school in the southern United States. The study findings indicate that fourth-year medical students do not differ from first-year medical students in terms of attitudes towards communication skills training or knowledge of appropriate provider-patient communication, but they have significantly higher confidence scores about communicating with patients. In addition, positive attitudes towards communication skills training are significantly related to perceived importance of communication skills and confidence when communicating with patients. Finally, female medical students have more positive attitudes towards communication skills training than male medical students. The implications of the study findings and directions for future research are also discussed.

Does a new integrated PBL curriculum with specific communication skills classes produce Pre Registration House Officers (PRHOs) with improved communication skills?

Over recent years communication skills training has played an increasingly important role in UK medical curricula. When The University of Liverpool reformed its medical curriculum in 1996 from a traditional lecture-based curriculum to an integrated problem-based learning curriculum formal communication skills training was introduced into the course. The paper deals with a comparison between PRHOs' ideas about communication competencies for PRHOs who did receive communication skills training and those involved in a traditional curriculum without formal communication training. This has involved distributing questionnaires to PRHOs and their educational supervisors, holding focus groups with PRHOs and interviewing educational supervisors. Data have been collected on the last cohort of the traditional curriculum and first cohort of the new curriculum to allow comparisons between cohorts. The PRHO questionnaires show that both cohorts feel they are good communicators but the focus groups show different reasons for this. The traditional graduates feel it is because doctors are 'natural communicators' and those skills can't be taught. The PBL graduates relate their communication skills to their undergraduate tuition and found they used these techniques when communicating as PRHOs. Both the questionnaires and interviews with the consultants demonstrate they feel the communication of PRHOs has significantly improved.

A survey of communication skills teaching at medical school

Communication is an essential component of surgical practice. Awareness of its importance is increasing among surgeons due to both the association between litigation and poor communication and recent requirements for obtaining informed consent. The General Medical Council has stated that medical students should have acquired and demonstrated their proficiency in communication by the end of their undergraduate education. Furthermore, communication skills assessment is now a pass/fail component of the intercollegiate MRCS examination of the surgical royal colleges.

Report of the Task Force on National Fourth Year Medical Student Emergency Medicine Curriculum Guide

This manuscript reports recommendations of the National Fourth Year Medical Student Emergency Medicine Curriculum Guide Task Force. This task force was convened by 6 major emergency medicine organizations to develop a standardized curriculum for fourth year medical students. The structure of the curriculum is based on clerkship curricula from other specialties such as internal medicine and pediatrics. The report contains a historical context, global and targeted needs assessment, goals and objectives, recommended educational strategies, implementation guidelines, and suggestions on feedback and evaluation.

Using standardized video cases for assessment of medical communication skills: reliability of an objective structured video examination by computer

OBJECTIVE

Using standardized video cases in a computerized objective structured video examination (OSVE) aims to measure cognitive scripts underlying overt communication behavior by questions on knowledge, understanding and performance. In this study the reliability of the OSVE assessment is analyzed using the generalizability theory.

METHODS

Third year undergraduate medical students from the Academic Medical Center of the University of Amsterdam answered short-essay questions on three video cases, respectively about history taking, breaking bad news, and decision making. Of 200 participants, 116 completed all three video cases. Students were assessed in three shifts, each using a set of parallel case editions. About half of all available exams were scored independently by two raters using a detailed rating manual derived from the other half. Analyzed were the reliability of the assessment, the inter-rater reliability, and interrelatedness of the three types of video cases and their parallel editions, by computing a generalizability coefficient G.

RESULTS

The test score showed a normal distribution. The students performed relatively well on the history taking type of video cases, and relatively poor on decision making and did relatively poor on the understanding ('knows why/when') type of questions. The reliability of the assessment was acceptable (G = 0.66). It can be improved by including up to seven cases in the OSVE. The inter-rater reliability was very good (G = 0.93). The parallel editions of the video cases appeared to be more alike (G = 0.60) than the three case types (G = 0.47).

DISCUSSION

The additional value of an OSVE is the differential picture that is obtained about covert cognitive scripts underlying overt communication behavior in different types of consultations, indicated by the differing levels of knowledge, understanding and performance. The validation of the OSVE score requires more research.

CONCLUSION AND PRACTICE IMPLICATIONS

A computerized OSVE has been successfully applied with third year undergraduate medical students. The test score meets psychometric criteria, enabling a proper discrimination between adequately and poorly performing students. The high inter-rater reliability indicates that a single rater is permitted.

Comparing self-reported communication skills of medical students in traditional and integrated curricula: a nationwide study

OBJECTIVES

To investigate medical students' self-assessments of their communication skills through medical school related to background factors, curriculum design and perceived medical school stress.

METHODS

Medical students at all year levels attending Norwegian universities in the spring of 2003 were mailed the Oslo Inventory of Self-reported Communication Skills (OSISCS) developed by the authors. Of the total number of students (N=3055), 60% responded. One school had a traditional curriculum, the other three ran integrated models.

RESULTS

Students assessed their instrumental communication skills to increase linearly year by year, while the relational skills showed a curve-linear trajectory reaching the optimum level half-way into the curriculum. Students attending the traditional school reported lower levels of instrumental skills compared to the students from the integrated schools. In relational skills, a similar difference was maintained half-way into the curriculum, but disappeared towards the end. Perceived medical school stress correlated to the self-reported end point levels of the two types of communication skills.

DISCUSSION

The trajectories of self-reported instrumental and relational skills indicate significant variations in facilitating mechanisms between curricula, cognitive processing and perceived medical school stress.

CONCLUSIONS

Self-reported instrumental and relational communication skills develop differently in medical students over the years according to the type of curriculum.

PRACTICE IMPLICATIONS

Curricula should be evaluated for improvement implementations.

Comparison of clinical skills of 3rd-year students who completed structured clinical skills program with 6th-year students who acquired clinical skills in unsystematic way

BACKGROUND

The timing and methods of teaching clinical skills are some of the main concerns of medical education.

PURPOSE

The aim of this study was to compare clinical skills of the 3rd and 6th-year students who acquired clinical skills training within different years and methods.

METHODS

Randomly chosen students were observed and evaluated in the form of "did it-didn't do it" over the checklists composed of parameters of communication, history taking, and physical examination. The results were evaluated on the SPSS 10.0 for Windows program and Pearson chi-square test was used in the statistical analyses.

RESULTS

Third-year students who had clinical skills training in early years and structured methods had better results for most of the parameters (p < .05).

CONCLUSIONS

The clinical skills training given through a structured program that is widespread in the early years of medical school makes a great contribution to the development of students' clinical skills.

Professionalism deficiencies in a first-quarter doctor-patient relationship course predict poor clinical performance in medical school

BACKGROUND

The purpose of this study was to determine whether four types of professionalism deficiencies in medical students identified during a first-year course on doctor-patient relationships might predict poor performance in third-year clerkships.

METHOD

Preceptors identified students who had deficiencies in interviewing patients: extreme shyness, poor process skills, paternalism, or a negative attitude toward interviewing. Deficient students were matched by academic ability to a control group. Performance on third-year clerkships was compared.

RESULTS

Students with paternalistic behavior or negative attitudes had significantly lower third-year grades.

CONCLUSIONS

Professionalism deficiencies that result in the inability of the student to establish patient rapport are detectable early and predict problems in future clinical performance.

Assessment of medical communication skills by computer: assessment method and student experiences

BACKGROUND

A computer-assisted assessment (CAA) program for communication skills designated ACT was developed using the objective structured video examination (OSVE) format. This method features assessment of cognitive scripts underlying communication behaviour, a broad range of communication problems covered in 1 assessment, highly standardised assessment and rating procedures, and large group assessments without complex organisation.

SETTING

The Academic Medical Centre (AMC) at the University of Amsterdam, the Netherlands. Aims To describe the development of the AMC Communication Test (ACT); to describe our experiences with the examination and rating procedures; to present test score descriptives, and to present the students' opinions of ACT.

DESIGN

The ACT presents films on history taking, breaking bad news and shared decision making. Each film is accompanied by 3 types of short essay questions derived from our assessment model: "knows", "knows why/when" and "knows how". Evaluation questions about ACT were integrated into the assessment. Participants A total of 210 third year medical undergraduates were assessed. This study reports on the 110 (53%) students who completed all evaluation questions.

RESULTS

Marking 210 examinations took about 17 days. The test score matched a normal distribution and showed a good level of discrimination of the students. About 75% passed the examination. Some support for the validity of our assessment model was found in the students' differential performance on the 3 types of questions. The ACT was well received. Student evaluations confirmed our efforts to develop realistic films that related well to the communication training programme.

CONCLUSIONS

The ACT is a useful assessment method which complements interpersonal assessment methods for the evaluation of the medical communication skills of undergraduates.

An educator's guide to teaching emergency medicine to medical students

There is a need for every medical school graduate to handle emergencies as they arise in the daily practice of medicine. Emergency medicine (EM) educators are in a unique position to provide students with basic life support skills, guidance in assessing the undifferentiated patient, and exposure to the specialty of EM during all years of medical school. Emergency physicians can become involved in a variety of education experiences that can supplement the preclinical curriculum and provide access to our specialty at an early stage. A well-designed course in the senior year allows students to develop critical thinking and patient management skills that are necessary for any medical career path. It can ensure that all medical students are exposed to the skills essential for evaluating and stabilizing the acutely ill patient. To implement this type of course, learning objectives and evaluation methods must be set when the curriculum is developed. An effective course combines didactic and clinical components that draw on the strengths of the teaching institution and faculty of the department. A structured clerkship orientation session and system for feedback to students are essential in nurturing the development of student learners. This article provides an approach to assist the medical student clerkship director in planning and implementing EM education experiences for students at all levels of training, with an emphasis on the senior-year rotation.

Experiences at the time of diagnosis of parents who have a child with a bone dysplasia resulting in short stature

Many studies have shown that, for families who are given the diagnosis of a disability, satisfaction with disclosure is an important element. Information given and the attitudes of the disclosing health professionals during this critical period have a significant effect on the coping and adaptation of the family. While most studies dealt with conditions involving intellectual disability or cancer, this study was conducted to explore parents' experience of being told that their child had a condition, such as a bone dysplasia, that would result in significant short stature. Semistructured interviews were conducted with 11 families who had children diagnosed with a bone dysplasia, specifically, achondroplasia (n = 9) and pseudoachondroplasia (n = 2). Families were recruited through the Bone Dysplasia Clinic at the Royal Children's Hospital, Victoria, Australia and via contact with the Short Statured People's Association of Victoria. Parents were asked about how they were told of their child's diagnosis, how they would have preferred to have been told, and what would have made the experience less distressing for them. Transcripts of the interviews were analyzed, and major themes were identified relating to the parents' experiences. Our data suggest that the manner in which the diagnosis is conveyed to the parents plays a significant role in their adjustment and acceptance. Provision of written information relating to the condition, possible medical complications, positive outlook for their child's future, and how to find social services and supports were some of the most significant issues for the parents. The multidisciplinary approach of the Bone Dysplasia Clinic was important to parents in the continued management of the families.

A hidden curriculum: mapping cultural competency in a medical programme

BACKGROUND

Cultural competency can be understood as those learned skills which help us understand cultural differences and ease communication between people who have different ways of understanding health, sickness and the body. Recently, medical schools have begun to recognise a need for cultural competency training. However, few reports have been published that articulate and evaluate cultural competency in medical curricula.

AIM

This study was performed in order to evaluate the current status of cultural competency training at a medical school in southern Sweden.

METHODS

We used a multimethod approach to curriculum evaluation. We reviewed the published list of learning objectives for the medical programme, interviewed curriculum directors and individual teachers for each term about course content and carried out focus group interviews with students in all stages of the medical programme.

RESULTS

Cultural competency is a present but mostly hidden part of the curriculum. We found learning objectives about cultural competency. Teachers reported a total of 25 instances of teaching that had culture or cultural competency as the main theme or 1 of many themes. Students reported few specific learning instances where cultural competency was the main theme. Students and teachers considered cultural competency training to be integrated into the medical programme. Cultural competency was not assessed.

CONCLUSION

This evaluation showed places in the curriculum where cultural competency is a present, absent or hidden part of the curriculum. The differences between the 3 perspectives on the curriculum lead us to propose curriculum changes. This study illustrates how triangulation with a multifactorial methodology leads to understanding of the current curriculum and changes for the future.

A discourse analysis study of 'good' and 'poor' communication in an OSCE: a proposed new framework for teaching students

BACKGROUND

There is still a great deal to be learnt about teaching and assessing undergraduate communication skills, particularly as formal teaching in this area expands. One approach is to use the summative assessments of these skills in formative ways. Discourse analysis of data collected from final year examinations sheds light on the grounds for assessing students as 'good' or 'poor' communicators. This approach can feed into the teaching/learning of communication skills in the undergraduate curriculum.

SETTING

A final year UK medical school objective structured clinical examination (OSCE).

METHODS

Four scenarios, designed to assess communication skills in challenging contexts, were included in the OSCE. Video recordings of all interactions at these stations were screened. A sample covering a range of good, average and poor performances were transcribed and analysed. Discourse analysis methods were used to identify 'key components of communicative style'.

FINDINGS

Analysis revealed important differences in communicative styles between candidates who scored highly and those who did poorly. These related to: empathetic versus 'retractive' styles of communicating; the importance of thematically staging a consultation, and the impact of values and assumptions on the outcome of a consultation.

CONCLUSION

Detailed discourse analysis sheds light on patterns of communicative style and provides an analytic language for students to raise awareness of their own communication. This challenges standard approaches to teaching communication and shows the value of using summative assessments in formative ways.

Directing student response to early patient contact by questionnaire

CONTEXT

First year medical students experienced early patient contact by observing outpatient consultations.

OBJECTIVES

To evaluate a questionnaire designed to examine emerging attitudes during the development of a doctor-patient relationship.

METHODS

First year medical students participated in medical outpatient consultations as observers. These consultations represented a total of 295 registered clinical appointments. After each observation, the students completed a questionnaire surveying themes related to the doctor-patient encounter. An instructor met the students at the end of the appointments to discuss the questions raised. The Dundee Ready Education Environment Measure was used to assess the course environment.

RESULTS

Students found the activity useful and enjoyable. They reported increased self-esteem and enhanced enthusiasm for the study of medicine. They completed write-ups describing and evaluating the questionnaire data. The questionnaire notes showed homogeneity among the students. The Dundee Measure indicated the students regarded the learning environment positively (62.2%); social and ambient conditions were rated highly (64.6% and 64.7%, respectively).

CONCLUSION

The teaching of humanitarian attitudes by observation of the doctor-patient relationship in practice was welcomed by students. The environment in which this educational programme was carried out was considered adequate. The outpatient service schedule and the limited time available for student instruction on the part of staff doctors made this activity productive. The programme motivated students towards higher achievement and the pursuit of medical responsibility as well as more developed humanitarian behaviour patterns.

Communication skills Assessed at OSCE are not Affected by Participation in the Adolescent Healthy Sexuality Program

PURPOSE

We proposed that first year medical students who voluntarily participated in the Healthy Sexuality adolescent program would perform better than their peers on an adolescent counseling station at the year-end OSCE (Objective Structured Clinical Examination). In addition we compared medical students? communication skills at the time of the program as assessed by self, peers and participating adolescents.

METHODS

Nineteen first year medical students voluntarily participated in the ongoing Healthy Sexuality program. Adolescent participants, medical student peer participants and medical students assessed communication comp onents on a 7-point Likert scale at the end of the program. At the year-end OSCE, all first year medical students at the University of Western Ontario were assessed at an adolescent counseling station by a standardized patient (SP) and a physician exa miner. Statistical analysis examined differences between the two groups.

RESULTS

Students who participated in the Healthy Sexuality program did not perform better than their colleagues on the year-end OSCE. A statistically significant correlation between physician examiner and SP evaluations was found (r = 0.62). Adolescent participants communication skills assessments in the Healthy Sexuality Program demonstrated no significant correlation with medical student assessments (self or peer).

CONCLUSIONS

Voluntary intervention with adolescents did not result in improved communication skills at the structured year-end examination. Further investigation will be directed towards delineating differences between SP and physician examiner assessments.

Evaluation of Speakers at a National Radiology Continuing Medical Education Course

PURPOSE

Evaluations of a national radiology continuing medical education (CME) course in thoracic imaging were analyzed to determine what constitutes effective and ineffective lecturing.

METHODS AND MATERIALS

Evaluations of sessions and individual speakers participating in a fiveday course jointly sponsored by the Society of Thoracic Radiology (STR) and the Radiological Society of North America (RSNA) were tallied by the RSNA Department of Data Management and three members of the STR Training Committee. Comments were collated and analyzed to determine the number of positive and negative comments and common themes related to ineffective lecturing.

RESULTS

Twenty-two sessions were evaluated by 234 (75.7%) of 309 professional registrants. Eighty-one speakers were evaluated by an average of 153 registrants (range, 2 - 313). Mean ratings for 10 items evaluating sessions ranged from 1.28 ? 2.05 (1=most positive, 4=least positive; SD .451 - .902). The average speaker rating was 5.7 (1=very poor, 7=outstanding; SD 0.94; range 4.3 - 6.4). Total number of comments analyzed was 862, with 505 (58.6%) considered positive and 404 (46.9%) considered negative (the total number exceeds 862 as a "comment" could consist of both positive and negative statements). Poor content was mentioned most frequently, making up 107 (26.5%) of 404 negative comments, and applied to 51 (63%) of 81 speakers. Other negative comments, in order of decreasing frequency, were related to delivery, image slides, command of the English language, text slides, and handouts.

CONCLUSIONS

Individual evaluations of speakers at a national CME course provided information regarding the quality of lectures that was not provided by evaluations of grouped presentations. Systematic review of speaker evaluations provided specific information related to the types and frequency of features related to ineffective lecturing. This information can be used to design CME course evaluations, design future CME course outcomes studies, provide training to presenters, and monitor presenter performance.

Communication skills assessment: the perceptions of medical students at the University of Nottingham

INTRODUCTION

Despite the wealth of literature surrounding communication curricula within medical education, there is a lack of in-depth research into medical students' perceptions of communication skills assessment. This study aims to address this gap in the research literature.

METHODS

Five focus group discussions were conducted with 32 students, with representatives from each of the 5 years of the medical degree course at Nottingham University. Audiotapes of the discussions were transcribed in full and the transcripts were theme analysed independently by 2 analysts.

RESULTS

Two assessment-related themes emerged from the analysis: namely, students' perceptions of formative assessment and students' perceptions of summative assessment. While students seemed to value formative methods of assessing their communication skills, they did not appear to value summative methods like objective structured clinical examinations (OSCEs). Students had mixed views about who should assess their oral communication skills. Some students preferred self-assessment while others preferred peer assessment. Although students appeared to value medical educators assessing their communication skills, other students preferred feedback from patients. Although summative methods like OSCEs were criticized widely, students suggested that examinations were essential to motivate students' learning of communication skills.

DISCUSSION

This study begins to illustrate medical students' perceptions of communication skills assessment. However, further research using large-scale surveys is required to validate these findings. Medical educators should provide students with feedback on their communication skills wherever possible. This feedback should ideally come from a combination of different assessors. Over-assessment in other subject areas should be minimized to prevent students being discouraged from learning communication skills.