Assessment of
communication skills
of undergraduate
medical students
J Voges
E Jordaan *
L Koen
DJH Niehaus
Servier Student Training Centre
Department 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

Substudies
 Facial
affect recognition
 Performance in oral examinations in
Psychiatry
 Communication 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 communication
 Conveys
and acknowledges information
 Contextualises meaning of verbal information
Doctors and patients gain information
about medical encounter
 Greater focus on verbal communication

 medical
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 skills
 Focus
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 rotation
 5 min. semi-structured interview with patient
that was videotaped
 Permission granted by Faculty of Health
Sciences and Ethics committee of SU
 Total of 301 video interviews

Venue:
 5-week
Psychiatry rotation at Stikland hospital
Methods

Assessment tool:
 Development
of rating scale
 Previous scales
 Items retained
 5-point rating results
 3-point rating

Statistical evaluation
 Item
response model
 Parameter 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
Percentage of students

60
50
40
30
20
10
0
0
1
2
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
Score
Results: Distribution of scores
0 = Lack of skill, 1 = Appropriate use of skill,
2 = Over-use of skill
70
Percentage of students

60
50
40
30
20
10
0
0
1
2
Posture
7.31
37.87
54.82
Attitude
5.65
41.86
52.49
1
32.23
66.78
7.31
40.53
52.16
Eye-contact
Lean
Score
Results: Item difficulty
-6
-4
-2
0
2
Distribution of thresholds
Lean
Nodding
Hand move
Posture
Facial exp
Attitude
Smile
Eye-cont
4
Results: Distribution of total nonverbal scores
Percentage
20
15
10
5
0
0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16
Percentage 1 1 1 3 2 4 5 4 10 11 16 14 16 7 3 3 0
Total score
Results: Distribution of appropriate
responses
25
Percentage
20
15
10
5
0
0
% 4.3
1
2
3
4
5
6
7
8
9
13 21 24 14 10 2.7 2.7
Number of appropriate responses
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

 Skill
 Raters
 Type
of patient
 Rating 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 FINLO
Faculty of Health Sciences