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 3 3

Evidence Good communication and patient centered care can lead to 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 4 4

Teaching Best Practice: Experiential Learning 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 5 5

Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano Teaching Methods

Teaching Content: Defined by consensus statements and blueprints 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 … 7 7

Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano The Kalamazoo II Report (and personal add ons): Five Ways to Assess Interpersonal and Communication Skills: Ratings of direct observation of interaction with real patients (global ratings of performance, checklist of specific behaviours, Mini-CEX) Ratings of simulated situations with standardized patients (OSCE, single simulated encounter, unannounced standardized patients) Ratings of video- and audiotape interaction (Video/audio review, checklist, linguistic-based analysis, RIAS) Patients questionnaire or survey (general patient analysis, survey following patient visits, patient complaints) 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

Longitudinal Curriculum in Basel Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano Longitudinal Curriculum in Basel 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 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 3 The Medical Interview Conduct a medical interview OSCE 4 Breaking Bad News Be able to break bad news to a patient 5 Clinical rotations 6 Clinical rotations, refresher: the medical interview

Objective Structured Clinical Examination 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 Knows (Knowledge) Knows how (Competence) Shows how (Performance) Does (Action) Miller GE: The assessment of clinical skills/competence/performance. 1990

Objective Structured Clinical Examination 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

Objective Structured Clinical Examination 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! 16

Rating scales for communication skills 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)

Rating scales for communication skills Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano Rating scales for communication skills Test score Error of measurement Version 2 Version 1 Case 1 Case 2 Case 3 Case 4 Case 5 Rater 1 Rater 2 Rater 4 Communication History taking Item 1 Item 2 Item 3 Item …

Rating scales for communication skills Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano Rating scales for communication skills Hodges 2002

Calgary Cambridge Guide Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano Calgary Cambridge Guide

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