LUCAS: a theoretically informed instrument to assess clinical communication in objective structured clinical examinations

Abstract

OBJECTIVES We reviewed papers describing the development of instruments for assessing clinical communication in undergraduate medical students. The instruments had important limitations: most lacked a theoretical basis, and their psychometric properties were often poor or inadequately investigated and reported. We therefore describe the development of a new instrument, the Liverpool Undergraduate Communication Assessment Scale (LUCAS), which is intended to overcome some of these limitations. We designed LUCAS to reflect the theory that communication is contextually dependent, inherently creative and cannot be fully described within a conceptual framework of discrete skills.METHODS We investigated the preliminary psychometric properties of LUCAS in two studies. To assess construct and external validity, we examined correlations between examiners' LUCAS ratings and simulated patients' ratings of their relationships with students in Year 1 formative (n = 384) and summative (n = 347) objective structured clinical examination (OSCE) samples. Item-total correlations and item difficulty analyses were also performed. The dimensionality of LUCAS was examined by confirmatory factor analysis. We also assessed interrater reliability; four raters used LUCAS to rate 40 video-recorded encounters between Year 1 students and simulated patients.RESULTS Simulated patient ratings correlated with examiner ratings across two OSCE datasets. All items correlated with the total score. Item difficulty showed LUCAS was able to discriminate between student performances. LUCAS had a two-dimensional factor structure: we labelled Factor 1 creative communication and Factor 2 procedural communication. The intraclass correlation coefficient was 0.73 (95% confidence interval 0.54-0.85), indicating acceptable reliability.CONCLUSIONS We designed LUCAS to move the primary focus of examiners away from an assessment of students' enactment of behavioural skills to a judgement of how well students' communication met patients' needs. LUCAS demonstrated adequate reliability and validity. The instrument can be administered easily and efficiently and is therefore suitable for use in medical school examinations.communication skills

Validating relationships among attachment, emotional intelligence and clinical communication

“…Students sequentially completed three PPC OSCE stations (a frustrated and worried SP presents with symptoms of a gastrointestinal bleed; an embarrassed and defensive SP presents with a sprained wrist and comorbid alcoholism; a concerned and assertive SP requests information about a bone scan). In each station, examiners rated students’ performance using the modified‐LUCAS, a checklist based on the LUCAS (Liverpool Undergraduate Communication Assessment Scale) . The modified‐LUCAS is tailored slightly to the requirements of each station, but always assesses competence across a range of areas, including the basic skills required for effective PPC (i.e.…”

The objective structured clinical examination revisited for postgraduate trainees in general practice

“…On the other hand, scores on some subscales of the OSCE (particularly addressing technical skills) appear to be more reliable than scores on other scales (e.g., communication). 18 Even the design (context) of the OSCE was, for unclear reasons, recognized as a moderator of the estimated reliability 6. The fact remains that validity testing of an OSCE is a hazardous piece of work: content validity, construct validity, and concurrent validity testing are subject to many moderating and uncontrollable factors.…”

4. Epistemological approaches to communication competence

“…A multiple groups CFA can look for error bias within a measure across various groups, which is clearly important for communication competence researchers who are conducting studies with large, diverse samples. Although CFAs are becoming more commonplace when examining various measures of communication competence (Bakke 2010;Ford et al 2012;Hullman 2007;Huntley et al 2012;Kelly et al 2010;Large, Giménez, and McCarthy 2009;Wheeless and BerrymanFink 1985), there are still relatively few examining some of the older measures of communication competence (especially those with multi-factors). However, there are some psychometricians that argue for a less rigid use of CFA especially for measures that have a history of highly reliable factor structures (McCrae et al 1996).…”

“…OSCEs have also been adapted for non-medical training for use in clinical counseling or psychological programs (Roux et al 2011) and social work programs (Lu et al 2011). Overall, numerous communication skills assessment measures have been developed to examine communication skills during an OSCE (Baig, Violato, and Crutcher 2010;Huntley et al 2012;Jiramaneerat 2009;Lu et al 2011;Nuovo, Bertakis, and Azari 2006;Roux et al 2011; for reviews see: Boon andStewart 1998 andSchirmer et al 2005). Another, less common technique, for evaluating student communication competence during interactions with patients is to train lay-people who follow medical students during clinical rounds (Bergus, Woodhead, and Kreiter 2009).…”