To what extent are medical interviewing skills teachable?

A clinical medicine level test at Jinan University School of Medicine reveals the importance of training medical students in clinical history-taking

Backgrounds

Training in the basic interview skills of clinical history-taking has always been a significant component of medical education.

Purpose

This study was designed to identify the factors influence medical students’ history-taking skills learning and develop a way to improve these skills.

Methods

We firstly analysed the academic performance of medical students at Jinan University School of Medicine in different disciplines of the Clinical Medicine Level Test (CMLT), to ensure the students have obtained comprehensive medical education prior to beginning their clinical internships. Next, we conducted a survey among the CMLT participants to seek the underlying causes and corresponding measures to improve history-taking in the future. Before these medical students entered their fifth-year clinical practice, we finally provide them with pre-internship training, including the history-taking workshops with standard patients (SP).

Results

The analysis of the clinical skill sections of the CMLT revealed that the students performed significantly better on clinical operations from multiple disciplines than on medical history-taking. Principal component analysis of the survey questionnaire indicated that the capability of history-taking, course assessments, and awareness of the value of medical history-taking emerged as the key factors forming a cohesive clue for sustaining history-taking implementation. The intervention workshops of employing SP had a positive impact, as evidenced by the students’ feedback and suggestions for improving their ability of history-taking.

Conclusions

This study suggests that strengthening of medical history-taking training is indispensable for training qualified medical students. Workshops with SP is a successful teaching strategy for practicing history-taking, allowing students to spot minute errors and training communication skills.

The Validity and Reliability of the Patient-Physician Interview Skill Evaluation Form in Five Steps

Objective: Developing basic and clinical communication and clinical reasoning skills is crucial in facilitating medical school students' future medical practice. The path to these skills` development goes through conducting patient-physician interviews. This research aims to conducted to determine the validity and reliability of the Patient-Physician Interview Skill Evaluation Form(P-PISEF) to be used in performance-based tests in the evaluation of patient-physician interview skills. Methods: This study has a descriptive and methodological design and was carried out in June-December 2021. The data were collected from the performance of 197 students with the evaluation of 18 faculty members using the developed form. Explanatory and confirmatory factor analyses, Cronbach's alpha and item the total score was analyzed. Results: The distribution of the eighteen lecturers (38.88%) was associate professors. P-PISEF, comprising 46 articles, five main sections, and seven components. Lecturers were evaluated in a certain order with over 70% compliance. Over 90% of evaluators evaluated P-PISEF similarly. The Cronbach's Alpha (α) was found at 0.793. The KMO value in this study is 0.733, and the data is moderately adequate for analysis. The result of the Bartlett's test was 5983.586 (p<0.05). This measurement shows that the variable we are measuring is multivariate in the sample parameter (specialty, career step, etc.). The total variance explained in this study was 57.577. Conclusion: P-PISEF is an evaluation tool that can be used in patient-physician interview simulations of medical students. The results help curriculum planners to arrange programs that address the development of medical interview skills more effectively.

A realist evaluation exploring simulated patient role-play in pharmacist undergraduate communication training

BACKGROUND

Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training.

METHODS

A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories.

RESULTS

Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated.

CONCLUSIONS

SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.

Comparison of Assessment by a Virtual Patient and by Clinician-Educators of Medical Students' History-Taking Skills: Exploratory Descriptive Study

BACKGROUND

A virtual patient (VP) can be a useful tool to foster the development of medical history-taking skills without the inherent constraints of the bedside setting. Although VPs hold the promise of contributing to the development of students' skills, documenting and assessing skills acquired through a VP is a challenge.

OBJECTIVE

We propose a framework for the automated assessment of medical history taking within a VP software and then test this framework by comparing VP scores with the judgment of 10 clinician-educators (CEs).

METHODS

We built upon 4 domains of medical history taking to be assessed (breadth, depth, logical sequence, and interviewing technique), adapting these to be implemented into a specific VP environment. A total of 10 CEs watched the screen recordings of 3 students to assess their performance first globally and then for each of the 4 domains.

RESULTS

The scores provided by the VPs were slightly higher but comparable with those given by the CEs for global performance and for depth, logical sequence, and interviewing technique. For breadth, the VP scores were higher for 2 of the 3 students compared with the CE scores.

CONCLUSIONS

Findings suggest that the VP assessment gives results akin to those that would be generated by CEs. Developing a model for what constitutes good history-taking performance in specific contexts may provide insights into how CEs generally think about assessment.

Comparing resident-patient encounters and case presentations in a family medicine clinic

OBJECTIVES

Oral case presentations following resident-patient interactions provide the primary mechanism by which faculty supervisors assess resident competence. However, the extent to which these presentations capture the content and quality of resident-patient communication during the encounter remains unknown. We aimed to determine whether: (i) the resident-patient encounter content matched information conveyed in the case presentation; (ii) the quality of resident-patient communication was accurately conveyed, and (iii) supervisors addressed effective and ineffective communication processes.

METHODS

A total of 22 pairs of resident-patient encounters and family medicine resident case presentations were video- or audiorecorded, transcribed and compared for content. Resident-patient communication was assessed using adapted versions of the Calgary-Cambridge Guide to the Medical Interview and Explanation and Planning Scale.

RESULTS

Interviews and presentations contained largely congruent content, but social history and the patient's perspective were consistently excluded from case presentations. Although six of 19 specific communication skills were used in over 80% of resident encounters, the effective use of communication skills was widely variable. In most presentations, the quality of resident-patient communication was not explicitly conveyed to the supervisor. Although resident presentations provided 'cues' about communication issues, supervisors rarely responded.

CONCLUSIONS

This study lends support to direct observation in workplace-based learning of communication skills. When content areas such as the patient's perspective and education are excluded, supervisors cannot address them. In addition, presentations provided minimal insight about the quality of resident-patient encounters and limited the ability to address communication skills. These skills could be enhanced by attending to communication cues during case presentations, making increased use of direct observation and feedback, and promoting faculty development to address these missed teaching opportunities.

Differences in expectations of passing standards in communication skills for pre-clinical and clinical medical students

OBJECTIVE

Communication and interpersonal skills (CIS) are essential elements of competency-based education. We examined defensible CIS passing levels for medical students completing basic sciences (second-year students) and clinical training (fourth-year students), using five standard setting methods.

METHODS

A 14-item CIS scale was used. Data from second-year (n = 190) and fourth-year (n = 170) students were analyzed using descriptive statistics and generalizability studies. Fifteen judges defined borderline CIS performance. Cut scores and fail rates from five standard setting methods (Angoff, Borderline-Group, Borderline-Regression, Contrasting-Groups, and Normative methods) were examined.

RESULTS

CIS performance was similar during second-year (Mean = 74%, SD = 6%) and fourth-year (Mean = 72%, SD = 5%) students. Judges using the Angoff method expected greater competence at the fourth-year level, as reflected in the Angoff cut scores (second-year = 53% with 0% fail, fourth-year = 66% with 10% fail). Cut scores from the remaining methods did not differentiate between training levels. We found evidence of case specificity.

CONCLUSION

Performance on CIS may be case specific. Passing standards for communication skills may require employing approaches such as the Angoff method that are sensitive to expectations of learner performance for different levels of training, competencies, and milestone levels.

PRACTICE IMPLICATIONS

Institutions that want to encourage continued growth in CIS should apply appropriate standard setting methods.

Dis-integration of communication in healthcare education: Workplace learning challenges and opportunities

The purpose of this paper, based on a 2016 Heidelberg International Conference on Communication in Healthcare (ICCH) plenary presentation, is to examine a key problem in communication skills training for health professional learners. Studies have pointed to a decline in medical students' communication skills and attitudes as they proceed through their education, particularly during their clinical workplace training experiences. This paper explores some of the key factors in this disintegration, drawing on selected literature and highlighting some curriculum efforts and research conducted at the University of Iowa Carver College of Medicine as a case study of these issues. Five key factors contributing to the disintegration of communication skills and attitudes are presented including: 1) lack of formal communication skills training during clinical clerkships; 2) informal workplace teaching failing to explicitly address learner clinical communication skills; 3) emphasizing content over process in relation to clinician-patient interactions; 4) the relationship between ideal communication models and the realities of clinical practice; and 5) clinical teachers' lack of knowledge and skills to effectively teach about communication in the clinical workplace. Within this discussion, potential practical responses by individual clinical teachers and broader curricular and faculty development efforts to address each of these factors are presented.

Teaching history taking to medical students: a systematic review

BACKGROUND

This paper is an up-to-date systematic review on educational interventions addressing history taking. The authors noted that despite the plethora of specialized training programs designed to enhance students' interviewing skills there had not been a review of the literature to assess the quality of each published method of teaching history taking in undergraduate medical education based on the evidence of the program's efficacy.

METHODS

The databases PubMed, PsycINFO, Google Scholar, opengrey, opendoar and SSRN were searched using key words related to medical education and history taking. Articles that described an educational intervention to improve medical students' history-taking skills were selected and reviewed. Included studies had to evaluate learning progress. Study quality was assessed using the Medical Education Research Study Quality Instrument (MERSQI).

RESULTS

Seventy-eight full-text articles were identified and reviewed; of these, 23 studies met the final inclusion criteria. Three studies applied an instructional approach using scripts, lectures, demonstrations and an online course. Seventeen studies applied a more experiential approach by implementing small group workshops including role-play, interviews with patients and feedback. Three studies applied a creative approach. Two of these studies made use of improvisational theatre and one introduced a simulation using Lego® building blocks. Twenty-two studies reported an improvement in students' history taking skills. Mean MERSQI score was 10.4 (range 6.5 to 14; SD = 2.65).

CONCLUSIONS

These findings suggest that several different educational interventions are effective in teaching history taking skills to medical students. Small group workshops including role-play and interviews with real patients, followed by feedback and discussion, are widespread and best investigated. Feedback using videotape review was also reported as particularly instructive. Students in the early preclinical state might profit from approaches helping them to focus on interview skills and not being distracted by thinking about differential diagnoses or clinical management. The heterogeneity of outcome data and the varied ways of assessment strongly suggest the need for further research as many studies did not meet basic methodological criteria. Randomized controlled trials using external assessment methods, standardized measurement tools and reporting long-term data are recommended to evaluate the efficacy of courses on history taking.

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review

OBJECTIVES

To explore inter-rater agreement between reviewers comparing reliability and validity of checklist forms that claim to assess the communication skills of undergraduate medical students in Objective Structured Clinical Examinations (OSCEs).

METHODS

Papers explaining rubrics of OSCE checklist forms were identified from Pubmed, Embase, PsycINFO, and the ProQuest Education Databases up to 2013. Included were those studies that report empirical validity or reliability values for the communication skills assessment checklists used. Excluded were those papers that did not report reliability or validity.

RESULTS

Papers focusing on generic communication skills, history taking, physician-patient communication, interviewing, negotiating treatment, information giving, empathy and 18 other domains (ICC -0.12-1) were identified. Regarding the validity and reliability of the communication skills checklists, agreement between reviewers was 0.45.

CONCLUSIONS

Heterogeneity in the rubrics used in the assessment of communication skills and a lack of agreement between reviewers makes comparison of student competences within and across institutions difficult.

PRACTICE IMPLICATIONS

Consideration should be afforded to the adoption of a standardized measurement instrument to assess communication skills in undergraduate medical education. Future research will focus upon evaluating the potential impact of adoption of a standardized measurement instrument.

Medical students' agenda-setting abilities during medical interviews

PURPOSE

Identifying patients' agendas is important; however, the extent of Korean medical students' agenda-setting abilities is unknown. The study aim was to investigate the patterns of Korean medical students' agenda solicitation.

METHODS

A total of 94 third-year medical students participated. One scenario involving a female patient with abdominal pain was created. Students were video-recorded as they interviewed the patient. To analyze whether students identify patients' reasons for visiting, a checklist was developed based on a modified version of the Calgary-Cambridge Guide to the Medical Interview: Communication Process checklist. The duration of the patient's initial statement of concerns was measured in seconds. The total number of patient concerns expressed before interruption and the types of interruption effected by the medical students were determined.

RESULTS

The medical students did not explore the patients' concerns and did not negotiate an agenda. Interruption of the patient's opening statement occurred in 4.62±2.20 seconds. The most common type of initial interruption was a recompleter (79.8%). Closed-ended questions were the most common question type in the second and third interruptions.

CONCLUSION

Agenda setting should be emphasized in the communication skills curriculum of medical students. The Korean Clinical Skills Exam must assess medical students' ability to set an agenda.

Teaching and learning consultation skills for paediatric practice

Effective consultations with patients and their families are important for patient satisfaction, adherence to treatment, and recovery from illness. Communication problems among health professionals are common. Fortunately, the skills of effective communication can be taught and learned. This paper highlights evidence based approaches to teaching these skills with minimal resources.

Instrumental strategy: A stage in students' consultation skills training? Observations and reflections on students' communication in general practice consultations

OBJECTIVES

To explore and examine students' abilities to communicate with patients during a general practice course in the final year of the curriculum and to analyse and consider this experience in relation to earlier consultation training.

SETTING

General practice courses in the undergraduate curriculum.

DESIGN

Qualitative data analysis was used. A special focus-group interview of experienced supervisors was performed and analysed (editing analysis). Credibility of data was tested at local seminars and conferences. Authors' experiences of observing student consultations over many years were also used.

RESULTS

A main theme, 'open invitation', emerged based on categories 'initially attentive' and 'listening attitude'. In contrast, the second main theme was 'instrumental strategy', based on the following categories: 'one-sided collection of medical facts' and 'relationship-building lost'. The students also had difficulties in devoting attention to patients' life experiences. An hourglass metaphor of students' and young physicians' progression of communication strategies is presented. The narrow part of the hourglass corresponds to an instrumental strategy at the end of undergraduate clinical education.

CONCLUSIONS

An instrumental strategy may be a stage in student's consultation learning progression that interferes with communication training. A question is raised: is training of a patient-centred approach throughout the clinical curriculum needed for optimal development of consultation skills? Further research is needed to test this hypothesis.

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.

Acquisition of communication skills in postgraduate training for general practice

PURPOSE

The evidence suggests that a longitudinal training of communication skills embedded in a rich clinical context is most effective. In this study we evaluated the acquisition of communication skills under such conditions.

METHODS

In a longitudinal design the communication skills of a randomly selected sample of 25 trainees of a three-year postgraduate training programme for general practice were assessed at the start and at the end of training. Eight videotaped real life consultations were rated per measurement and per trainee, using the MAAS-Global scoring list. The results were compared with each other and with those of a reference group of 94 experienced GPs.

RESULTS

The mean score of the MAAS-Global was slightly increased at the end of training (2.4) compared with the start (2.2). No significant difference was found between the final results of the trainees and the reference group. According to the criteria of the rating scale the performance of both trainees and GPs was unsatisfactory.

CONCLUSION

The results of this study indicate that communication skills do not improve in a three-year postgraduate training comprising both a rich clinical context and a longitudinal training of communication skills, and that an unsatisfactory level still exists at the end of training. Moreover, GPs do not acquire communication skills during independent practice as they perform comparably to the trainees. Further research into the measurement of communication skills, the teaching procedures, the role of the GP-trainer as a model and the influence of rotations through hospitals and the like, is required.

Predicting communication skills with a paper-and-pencil test

AIM

This study was conducted to investigate the value of a written knowledge test of communication skills for predicting scores on a performance test of communication skills.

METHOD

A paper-and-pencil test of knowledge about communication skills and a performance test of communication skills, consisting of four stations with standardised patients, were administered to students of two classes of the medical schools of Maastricht and Leiden, the Netherlands. The results on these tests were compared.

RESULTS

From the results of both instruments, the classes of the participating students could be recognised equally well: 60% correct qualifications of the classes by the knowledge test and 64% by the multiple station examination. Between the two tests an overall, disattenuated correlation of 0.60 was found (N=133, P < 0.01), suggesting moderate predictive value of the knowledge test for the performance test of communication skills. The correlation is stronger for students from Maastricht medical school than for their colleagues in Leiden. Correlation between the knowledge of communication skills test and other available test results of the participating Maastricht students is close to zero, suggesting that the test measures a distinct quality of students' competence.

DISCUSSION

The paper-and-pencil test of knowledge of communication skills has predictive value for the performance of these skills, but this value seems to be less pronounced than similar findings for clinical procedural skills. The stronger relationship between 'knowing how' and 'showing' in the Maastricht student group might be indicative of an effect of the training format.

Influence of gender on outcomes of medication-history interviewing

This study investigated the influence of patient and provider gender on the outcomes of medication-history interviewing. In a previous study, 112 pharmacy students conducted medication-history interviews with 2 simulated patients. A secondary analysis was accomplished using complete data from 85 of the original 112 pharmacy students. The other 27 students were eliminated because of missing data. Factor analysis and canonical correlation were used to assess associations between the prior study's set of predictor variables and measures of interview completeness and patient satisfaction with the interview. Female and male pharmacy students appear to use different expressive, interactive, and interrogative skills. Allergy-asking was more complete when female pharmacy students interviewed a male patient. Emotive patient satisfaction was found to be associated more positively with a female student and female patient while teleological patient satisfaction between a male student and male patient was nearly double the result of the female-female dyad. Medication-history interview outcomes appear to differ as a consequence of the use of different sets of skills during same-sex or opposite-sex interviews.

Retention of interviewing skills learned by first-year medical students: a longitudinal study

A pilot interviewing course was offered as an elective to first-year medical students in the spring of 1985. A quasi-experimental pre-test/post-test control group demonstrated that students who took the course exhibited a significant increase in interviewing skills. Subjects, 15 in the experimental group and 11 in the control group, were assessed in each of the following 3 years. Data consisted of five 10-minute videotaped interviews with real or stimulated patients for each subject and subject's responses on a degree of confidence, familiarity and anxiety scale. Interviews were rated on 43 behaviours by two independent coders with a 90% simple agreement. The experimental group did not maintain their scores on interviewing skills and both groups showed a significant decline in nine skills comprising empathy. The only significant difference between the groups in fourth year was on the degree of confidence experienced. While interviewing skills can be learned they decline in the clinical years as students learn medical problem-solving. If medical students are to graduate with their original empathy intact, a follow-up course in fourth year is indicated.