1. Assessment of Communication Skills in Medical Education
Dr. med. Claudia Kiessling, MPH
Basel

2. Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano

3. Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano
Systematic review included 21 randomized controlled and analytic studies between 1983 – positive results 4 negative (i.e. non sign.) 1 inconclusive results for a correlation between doctor-patient comm. & health outcomes 3 3

4. 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

5. 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

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

7. 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

8. 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)

9. Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano
Assessing

10. 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

11. 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

12. 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

13. 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

14. 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

15. Objective Structured Clinical Examination
Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano
Objective Structured Clinical Examination

16. 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

17. 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)

18. 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 …

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

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

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

22. Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano

23. Assessment of Communication Skills in Medical Education February, 18th 2011 Lugano