Assessment of communication skills of undergraduate medical students

J VogesE Jordaan *

L KoenDJH Niehaus

Servier Student Training CentreDepartment of Psychiatry, University of Stellenbosch and Stikland

Hospital* Biostatistics Unit: Medical Research Council, Bellville

Positioning of study

Correlation of communication skills of undergraduate medical students with academic performance

SubstudiesFacial affect recognitionPerformance in oral examinations in

PsychiatryCommunication skills: Verbal and non-verbal

Introduction Effective medical practitioners require

communication competency Successful communication

Improved satisfaction Treatment compliance Strong predictor of medical school success

Ineffective communication Malpractice claims Medication errors

Interpersonal communication includes content and relational components

Introduction

Non-verbal communicationConveys and acknowledges informationContextualises meaning of verbal information

Doctors and patients gain information about medical encounter

Greater focus on verbal communicationmedical education communication research

Assessment of communication skills

Complex Close to real-life encounter Verbal communication skills

Adapted Liverpool communication skills assessment scale

Non-verbal communication skillsFocus of presentation

Aim

First phase: To develop a psychometrically sound non-verbal

assessment tool Comprehensive Valid within study population User-friendly

Second phase: Determine whether there is a correlation

between non-verbal communication skills and academic performance

Methods

Subjects:Medical students completing late rotation5 min. semi-structured interview with patient

that was videotapedPermission granted by Faculty of Health

Sciences and Ethics committee of SUTotal of 301 video interviews

Venue:5-week Psychiatry rotation at Stikland hospital

Methods Assessment tool:

Development of rating scalePrevious scales Items retained5-point rating results3-point rating

Statistical evaluation Item response modelParameter estimation

Non-verbal scale Body orientation (Lean) Body posture Attitude Facial expressivity Hand movement Frequency of smiling Frequency of nodding Eye-contact

Ordinal measurement scale: 0: Displayed lack of skill 1: Appropriate use of skill 2: Over-use of skill

Results: Distribution of scores 0 = Lack of skill, 1 = Appropriate use of skill,

2 = Over-use of skill

0

10

20

30

40

50

60

Pe

rce

nta

ge

of

stu

de

nts

Score

Hand movement 43.85 46.84 9.3

Smile 37.21 53.16 9.63

Facial expression 27.57 54.82 17.61

Nodding 11.3 54.82 33.89

0 1 2

Results: Distribution of scores 0 = Lack of skill, 1 = Appropriate use of skill,

2 = Over-use of skill

0

10

20

30

40

50

60

70P

erc

en

tag

e o

f stu

den

ts

Score

Posture 7.31 37.87 54.82

Attitude 5.65 41.86 52.49

Eye-contact 1 32.23 66.78

Lean 7.31 40.53 52.16

0 1 2

Results: Item difficulty

-6 -4 -2 0 2 4

Distribution of thresholds

Lean Hand move Facial exp Smile

Nodding Posture Attitude Eye-cont

Results: Distribution of total non-verbal scores

0

5

10

15

20P

erce

ntag

e

Total score

Percentage 1 1 1 3 2 4 5 4 10 11 16 14 16 7 3 3 0

0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16

Results: Distribution of appropriate responses

0

5

10

15

20

25

Pe

rce

nta

ge

Number of appropriate responses

% 4.3 9 13 21 24 14 10 2.7 2.7

0 1 2 3 4 5 6 7 8

Preliminary correlation with academic performance

Discussion

Composite non-verbal communication scale

3-point ordinal rating scale Acceptable scale for measuring latent

variable Non-verbal communication Suggestions for using total score and

individual items

Limitations and recommendations

More difficult items High number of maximum scores

SkillRatersType of patientRating scale

Patient population Sample size

Correlation with academic performance

Selected references Epstein, R.M., Campbell, T.L., Cohen-Cole, S.A., McWhinney,

I.R. & Smilkstein, G. (1993). Perspectives on patient-doctor communication. Journal of Family Practice 37(4): 377–388.

Griffith, C., Wilson, J., Lanfer, S. & Haist, S. (2003). House staff nonverbal communication skills and standardized patient satisfaction. Journal of General Internal Medicine 18: 170–174.

Ishikawa, H., Hashimoto, H., Kinoshita, M., Fujimori, S., Shimizu, T. & Yano, E. (2006). Evaluating medical students’ non-verbal communication during the objective structured clinical examination. Medical education 40: 1180–1187.

Parker, G. (1993). On our selection: predictors of medical school success. Medical Journal of Australia 158(11): 747–751.

Project supported by funding from FINLOFaculty of Health Sciences