Assessment of Communication Skills
in Medical Education
Dr. med. Claudia Kiessling, MPH
Basel
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Systematic review included
21 randomized controlled
and analytic studies
between 1983 – 1993
16 positive results
4 negative (i.e. non sign.)
1 inconclusive results
for a correlation between
doctor-patient comm. &
health outcomes
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
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
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Teaching
Best Practice: Experiential Learning
• Demonstration of best practice
• Observation and feedback
• Ongoing training and reinforcement
• Fostering self awareness, self reflection, self assessment
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Teaching Methods
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Teaching
Content: Defined by consensus statements and blueprints
• Toronto Consensus Statement
• Kalamazoo Consensus Statement
• Basel Consensus Statement
• Swiss Catalogue of Learning Objectives
•…
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Assessment
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 of Communication Skills in Medical Education
February, 18th 2011 Lugano
Assessing
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Maturity of Clinical Communication Skills
Teaching (according to J. Silverman 2008)
Full integrated
multi-method
assessment
Longitudinal curriculum
with clinical integration
Longitudinal curriculum
Multiple stand-alone courses
throughout years
Single stand-alone course in early years
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Longitudinal Curriculum in Basel
Year
Content
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
Assess.
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
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
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
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
Does
(Action)
Shows how
(Performance)
Knows how
(Competence)
Knows
(Knowledge)
Miller GE: The assessment of clinical
skills/competence/performance. 1990
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Objective Structured Clinical Examination
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
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Objective Structured Clinical Examination
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Weakest graduates
Best graduates
Low scores in
communication skills
are predictive for more
patient complaints!
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
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)
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Rating scales for communication skills
Test score
Version 1
Case 1
Rater 1
Rater 2
Version 2
Case 2
Rater 2 Rater 4
Communication
History taking
Item 1
Item 1
Item 2
Item 2
Item 3
Item 3
Item …
Item …
Error of measurement
Case 3
Case 4
Case 5
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Rating scales for communication skills
Hodges 2002
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Calgary Cambridge Guide
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Calgary Cambridge Guide
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano
Assessment of Communication Skills in Medical Education
February, 18th 2011 Lugano