Communication Skills in Standardized-Patient Assessment of Final-Year Medical Students: A Psychometric Study

Abstract

The purpose of this study is to investigate the content-specificity of communication skills. It investigates the reliability and dimensionality of standardized patient (SP) ratings of communication skills in an Objective Structured Clinical Examination (OSCE) for final year medical students. An OSCE consisting of seven standardized patient (SP) encounters was administered to final-year medical students at four medical schools that are members of the California Consortium for the Assessment of Clinical Competence (N = 567). For each case, SPs rated students' communication skills on the same seven items. Internal consistency coefficients were calculated and a two-facet generalizability study was performed to investigate the reliability of the scores. An exploratory factor analysis was conducted to examine the dimensionality of the exam. Findings indicate that communication skills across the seven-case examination demonstrate a reliable generic component that supports relative decision making, but that a significant case-by-student interaction exists. The underlying structure further supports the case-specific nature of students' ability to communicate with patients. From these findings, it is evident that individual's communication skills vary systematically with specific cases. Implications include the need to consider the range of communication skill demands made across the OSCE to support generalization of findings, the need for instruction to provide feedback on communication skills in multiple contexts, and the need for research to further examine the student, patient, and presenting problem as sources of variation in communication skills.

Interpersonal Dynamics in Assessment Center Exercises

“…In line with the exercise effects found in the AC, education, and medical literatures (e.g., Guiton et al, 2004;Hodges et al, 1996;Lance et al, 2004;Putka & Hoffman, 2013), the substantial variability in participant performance across exercises was confirmed in the current study as there was considerable variance in interpersonal behavior for participants who completed two exercises. The correlation of participant use of relationship building across the two exercises was small, and there was a nonsignficant correlation for participant use of directive communication across exercises.…”

Influence of Patients’ Requests for Direct-to-Consumer Advertised Antidepressants

“…5 Standardized patients have been used in medical education, quality assessment, and, increasingly, in research. [43][44][45][46][47] External validity of SP-based research might be threatened if SP roles are unrealistic or extreme, SP portrayals are of poor quality, or physicians "detect" the presence of an SP and act differently as a result. Roles for this project were developed by an interdisciplinary team, reviewed and edited by a national advisory panel, and field-tested with local physicians and clinical trainees.…”

Ratings of Physician Communication by Real and Standardized Patients

“…5 Patients also respond in a global manner when rating their physicians, with high correlations among scales measuring Kevin Fiscella, MD Standardized patients-persons trained to portray a specifi c patient case in a standardized fashion 8 -represent a potentially more objective means for assessment of physician communication. Standardized patients can be trained to rate physician-patient communications skills reliably 9,10 and are used by medical schools and the US Medical Licensure Examination to assess competence. 8,11,12 Unannounced standardized patients have also been used in research to rate community physicians' history taking, physical examination, medical decision making, and communication, as well as health services utilization and quality of care.…”