Assessment of Communication Skills in Medical Education

Assessment of Communication Skills in Medical Education

Dr. med. Claudia Kiessling, MPH

Basel

Assessment of Communication Skills in Medical EducationFebruary, 18th 2011 Lugano


Systematic review included 21 randomized controlled and analytic studies between 1983 – 199316 positive results4 negative (i.e. non sign.)1 inconclusive resultsfor a correlation between doctor-patient comm. & health outcomes


Evidence

Good communication and patient centered care can lead to

• Better health outcomes

• greater patient satisfaction and adherence

• greater symptom improvement

• better management of chronic conditions

• fewer medication errors

• reduction of diagnostic testing and referrals

• greater doctor satisfaction (prevention of burn out)

Rider et al. 2007


Teaching

Best Practice: Experiential Learning

• Demonstration of best practice

• Observation and feedback

• Ongoing training and reinforcement

• Fostering self awareness, self reflection, self assessment

Teaching Methods



Teaching

Content: Defined by consensus statements and blueprints

• Toronto Consensus Statement

• Kalamazoo Consensus Statement

• Basel Consensus Statement

• Swiss Catalogue of Learning Objectives

• …

The Kalamazoo II Report (and personal add ons): Five Ways to Assess Interpersonal and Communication Skills:

1. Ratings of direct observation of interaction with real patients (global ratings of performance, checklist of specific behaviours, Mini-CEX)

2. Ratings of simulated situations with standardized patients (OSCE, single simulated encounter, unannounced standardized patients)

3. Ratings of video- and audiotape interaction (Video/audio review, checklist, linguistic-based analysis, RIAS)

4. Patients questionnaire or survey (general patient analysis, survey following patient visits, patient complaints)

5. Examination of knowledge, procedural knowledge, scripts, perceptions,

and attitudes (MCQ, computer-based exercise, empathy and emotional intelligence scale, Script concordance test, Situational judgement test)


Assessment

Assessing


Maturity of Clinical Communication Skills Teaching (according to J. Silverman 2008)

Single stand-alone course in early years

Multiple stand-alone courses throughout years

Longitudinal curriculum

Longitudinal curriculum with clinical integration

Full integrated multi-methodassessment


Year Content Assess.

1 Basics of doctor-Patient communication, Biopsychosocial model, giving and receiving feedback (4 hours lectures, 2 hours small group)

2 Communication techniques (WWSZ, NURSE, structuring)(3 hours lectures, 4 hours small group)

3 The Medical Interview(12 hours small group)

4 Breaking Bad News(3 hours small group)

5 Clinical rotations

6 Clinical rotations, refresher: the medical interview


Longitudinal Curriculum in Basel

Year Content Assess.

1 Basics of doctor-Patient communciation, Biopsychosocial model, giving and receiving feedback

Be able to give feedback to another student

Video

2 Communication techniques (WWSZ, NURSE, structuring)

Analyse communication techniques in a medical interview

Video

3 The Medical Interview

Conduct a medical interview

OSCE

4 Breaking Bad News

Be able to break bad news to a patient

OSCE

5 Clinical rotations

6 Clinical rotations, refresher: the medical interview


Longitudinal Curriculum in Basel


Objective Structured Clinical Examination

Examination to assess clinical skills:

• History taking and physical examination

• Communication skills

• Clinical Procedures (e.g. suturing, vene puncture)

• Clinical reasoning (summarize and interpret findings, define a working hypothesis, develop management plan)

• Interpret e.g. x-rays, lab findings, ECG

Knows (Knowledge)

Knows how (Competence)

Shows how (Performance)

Does(Action)

Miller GE: The assessment of clinical skills/competence/performance. 1990



How to run an OSCE

• Students have to manage a parcour with different stations (e.g. 10)

• All stations have the same length (e.g. 8 minutes)

• All students do the same stations

• The student reads the task of the first station in front of a room, after

a signal he enters the room and demonstrates the task.

• An examiner observes the student’s performance and scores it on a predefined checklist or rating scale

• The station ends after a second signal. The student leaves the room

and goes to the next station.

• and so on … in 80 minutes you can test 10 students with 10 stations



Low scores in communication skills are predictive for more patient complaints!


Best graduates

Weakest graduates


Rating scales for communication skills

How to choose or develop an appropriate instrument

• Construct to be measured - objectives and content of teaching

• What else will be tested during the station (history taking, etc.) feasibility

• Who will be the examiner (doctor, patient, …)

• Checklist or rating scale (yes/no; 1-10; strongly agree – disagree)

• Psychometrics (reliability, validity)



Case 1 Case 2 Case 3 Case 4 Case 5

Test score Error of measurement

Version 2Version 1

Rater 1 Rater 2 Rater 2 Rater 4

Communication History taking

Item 1

Item 2

Item 3

Item …

Item 1

Item 2

Item 3

Item …



Hodges 2002


Calgary Cambridge Guide


Calgary Cambridge Guide



Documents

Assessment of Communication Skills in Medical Education