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Chen X, Luo L, Jiang L, Shi L, Yang L, Zeng Y, Li F, Li L. Development of the nurse's communication ability with angry patients scale and evaluation of its psychometric properties. J Adv Nurs 2021; 77:2700-2708. [PMID: 33629754 PMCID: PMC8248006 DOI: 10.1111/jan.14788] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 01/18/2021] [Accepted: 01/27/2021] [Indexed: 11/28/2022]
Abstract
AIMS To develop the Nurse's Communication Ability with Angry Patients Scale (NCAAPS) and evaluate its psychometric properties. DESIGN An instrument development and validation study. METHODS The survey was administered to 501 nurses from different emergency departments in China between 2 August 2019 and 3 October 2019. Data from 456 completed questionnaires were analysed to identify the factor structure of the NCAAPS. RESULTS The content validity index was satisfactory. Four factors were included and 71.25% of the total variance was explained by 19 items in NCAAPS. Confirmatory factor analysis supported the four-factor structure. Cronbach's α coefficient was 0.96 for the overall scale and 0.81-0.92 for its subscales. Test-retest reliability was 0.740. CONCLUSION We consider the NCAAPS to be a useful tool for measuring the ability of nurses to communicate with angry patients. IMPACT It is anticipated that this new scale will help educators to identify specific areas of deficiency that could be targeted with training to improve the ability of nursing staff to communicate with angry patients.
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Affiliation(s)
- Xi Chen
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liumei Luo
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Ling Jiang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Liumin Shi
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Yang
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Yuting Zeng
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Fang Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
| | - Li Li
- Teaching and Research Section of Clinical Nursing, Xiangya Hospital of Central South University, Changsha, Hunan, China.,Clinical Nursing Research Center, Xiangya Hospital of Central South University, Changsha, Hunan, China
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Hulsman RL, Peters JF, Fabriek M. Peer-assessment of medical communication skills: the impact of students' personality, academic and social reputation on behavioural assessment. PATIENT EDUCATION AND COUNSELING 2013; 92:346-54. [PMID: 23916674 DOI: 10.1016/j.pec.2013.07.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2013] [Revised: 07/01/2013] [Accepted: 07/02/2013] [Indexed: 05/21/2023]
Abstract
OBJECTIVE Peer-assessment of communication skills may contribute to mastery of assessment criteria. When students develop the capacity to judge their peers' performance, they might improve their capacity to examine their own clinical performance. In this study peer-assessment ratings are compared to teacher-assessment ratings. The aim of this paper is to explore the impact of personality and social reputation as source of bias in assessment of communication skills. METHODS Second year students were trained and assessed history taking communication skills. Peers rated the students' personality and academic and social reputation. RESULTS Peer-assessment ratings were significantly correlated with teacher-ratings in a summative assessment of medical communication. Peers did not provide negative ratings on final scales but did provide negative ratings on subcategories. Peer- and teacher-assessments were both related to the students' personality and academic reputation. CONCLUSION Peer-assessment cannot replace teacher-assessment if the assessment should result in high-stake decisions about students. Our data do not confirm the hypothesis that peers are overly biased by personality and reputation characteristics in peer-assessment of performance. PRACTICE IMPLICATIONS Early introduction of peer-assessment in medical education would facilitate early acceptance of this mode of evaluation and would promote early on the habit of critical evaluation of professional clinical performance and acceptance of being evaluated critically by peers.
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Affiliation(s)
- Robert L Hulsman
- Academic Medical Centre, Department of Medical Psychology, Amsterdam, The Netherlands.
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Wiskin C, Doherty EM, von Fragstein M, Laidlaw A, Salisbury H. How do United Kingdom (UK) medical schools identify and support undergraduate medical students who 'fail' communication assessments? A national survey. BMC MEDICAL EDUCATION 2013; 13:95. [PMID: 23834990 PMCID: PMC3720201 DOI: 10.1186/1472-6920-13-95] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2012] [Accepted: 06/17/2013] [Indexed: 05/23/2023]
Abstract
BACKGROUND The doctor's ability to communicate effectively (with patients, relatives, advocates and healthcare colleagues) relates directly to health outcomes, and so is core to clinical practice. The remediation of medical students' clinical communication ability is rarely addressed in medical education literature. There is nothing in the current literature reporting a contemporary national picture of how communication difficulties are managed, and the level of consequence (progression implications) for students of performing poorly. This survey aimed to consolidate practices for identifying and processes for managing students who 'fail' communication assessments across all UK medical schools. METHODS Data were collected via an email survey to all leads for clinical communication in all UK Medical Schools for the UK Council for Clinical Communication in Undergraduate Medical Education. RESULTS All but two participating Schools reported some means of support and/or remediation in communication. There was diversity of approach, and variance in the level of systemisation adopted. Variables such as individuality of curricula, resourcing issues, student cohort size and methodological preferences were implicated as explaining diversity. Support is relatively ad hoc, and often in the hands of a particular dedicated individual or team with an interest in communication delivery with few Schools reporting robust, centralised, school level processes. CONCLUSIONS This survey has demonstrated that few Medical Schools have no identifiable system of managing their students' clinical communication difficulties. However, some Schools reported ad hoc approaches and only a small number had a centralised programme. There is scope for discussion and benchmarking of best practice across all Schools with allocation of appropriate resources to support this.
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Affiliation(s)
- Connie Wiskin
- Primary Care Clinical Sciences, College of Medical and Dental Sciences, University of Birmingham, Edgbaston B15 2TT, Birmingham, UK
| | - Eva M Doherty
- The Royal College of Surgeons in Ireland, National Surgical Training Centre, St Stephens Green, Dublin, Ireland
| | - Martin von Fragstein
- Division of Primary Care, Community Health Sciences, University of Derby, Derby, UK
| | - Anita Laidlaw
- Medical School, University of St Andrews, St Andrews, Fife, Scotland, UK
| | - Helen Salisbury
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
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4
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Kelley KA, Stanke LD, Rabi SM, Kuba SE, Janke KK. Cross-validation of an instrument for measuring professionalism behaviors. AMERICAN JOURNAL OF PHARMACEUTICAL EDUCATION 2011; 75:179. [PMID: 22171107 PMCID: PMC3230340 DOI: 10.5688/ajpe759179] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2011] [Accepted: 06/21/2011] [Indexed: 05/17/2023]
Abstract
OBJECTIVE To cross-validate an instrument to measure behavioral aspects of professionalism in pharmacy students using a rating scale that minimizes ceiling effects. METHODS Seven institutions collaborated to create a 33-item assessment tool that included 5 domains of professionalism: (1) Reliability, Responsibility and Accountability; (2) Lifelong Learning and Adaptability; (3) Relationships with Others; (4) Upholding Principles of Integrity and Respect; and (5) Citizenship and Professional Engagement. Each item was rated based on 5 levels of competency which were aligned with a modified Miller's Taxonomy (Knows, Knows How, Shows, Shows How and Does, and Teaches). RESULTS Factor analyses confirmed the presence of 5 domains for professionalism. The factor analyses from the 7-school pilot study demonstrated that professionalism items were good fits within each of the 5 domains. CONCLUSIONS Based on a multi-institutional pilot study, data from the Professionalism Assessment Tool (PAT), provide evidence for internal validity and reliability. Use of the tool by external evaluators should be explored in future research.
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Dielissen P, Bottema B, Verdonk P, Lagro-Janssen T. Attention to gender in communication skills assessment instruments in medical education: a review. MEDICAL EDUCATION 2011; 45:239-48. [PMID: 21299599 DOI: 10.1111/j.1365-2923.2010.03876.x] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/22/2023]
Abstract
CONTEXT Gender is increasingly regarded as an important factor in doctor-patient communication education. This review aims to assess if and how gender is addressed by current assessment instruments for communication skills in medical education. METHODS In 2009 at Radboud University Nijmegen Medical Centre, an online search was conducted in the bibliographic databases PubMed, PsycINFO and ERIC for references about communication skills assessment instruments designed to be completed by trained faculty staff and used in medical education. The search strategy used the following search terms: 'consultation skills'; 'doctor-patient communication'; 'physician-patient relations'; 'medical education'; 'instruments'; 'measurement', and 'assessment'. Papers published between January 1999 and June 2009 were included. The assessment instruments identified were analysed for gender-specific content. RESULTS The search yielded 21 communication skills assessment instruments. Only two of the 17 checklists obtained explicitly considered gender as a communication-related issue. Only six of 21 manuals considered gender in any way and none gave specific details to explain which aspects of communication behaviour should be assessed with regard to gender. CONCLUSIONS Very few communication assessment instruments in medical education focus on gender. Nevertheless, interest exists in using gender in communication skills assessment. The criteria for and purpose of assessing gender in communication skills in medical education are yet to be clarified.
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Affiliation(s)
- Patrick Dielissen
- Department of Primary Care and Community Care, Centre for Family Medicine, Geriatric Care and Public Health, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
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Perry M, Maffulli N, Willson S, Morrissey D. The effectiveness of arts-based interventions in medical education: a literature review. MEDICAL EDUCATION 2011; 45:141-8. [PMID: 21208260 DOI: 10.1111/j.1365-2923.2010.03848.x] [Citation(s) in RCA: 90] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
CONTEXT arts-based interventions, which aim to foster understanding of the patient's perspective and to enhance communication skills, have been part of the medical curriculum for several years. This review aims to evaluate the available evidence base for their effectiveness and to suggest the nature of future work. METHODS the MEDLINE, Google Scholar and ISI Web of Knowledge databases were searched for published articles on studies that have attempted to evaluate the efficacy of an arts-based approach in undergraduate medical education. Further articles were identified through cross-referencing, discussion with colleagues and hand-searching key journals. One mixed, 10 qualitative and four quantitative studies were reviewed. RESULTS some studies claim that arts-based interventions are effective in altering attitudes, but poor descriptions of methodology and results make it difficult to judge these claims. No studies consider the effects on behaviour. The evidence base for using arts-based interventions to foster diagnostic observation skills is stronger. However, their effect on other clinical skills has not been studied. CONCLUSIONS there is a need for further studies to produce a rigorous evaluation of arts-based interventions in terms of their effects on attitudes, behaviour and technical skills other than those involved in observation.
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Affiliation(s)
- Mark Perry
- Centre for Sports and Exercise Medicine, Mile End Hospital, Queen Mary University of London, London, UK.
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7
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Hauer KE, Holmboe ES, Kogan JR. Twelve tips for implementing tools for direct observation of medical trainees' clinical skills during patient encounters. MEDICAL TEACHER 2011; 33:27-33. [PMID: 20874011 DOI: 10.3109/0142159x.2010.507710] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
BACKGROUND Direct observation of medical trainees by their supervisors with actual patients is essential for trainees to develop clinical skills competence. Despite the many available tools for direct observation of trainees by supervisors, it is unclear how educators should identify an appropriate tool for a particular clinical setting and implement the tool to maximize educational benefits for trainees in a manner that is feasible for faculty. AIMS AND METHODS Based on our previous systematic review of the literature, we provide 12 tips for selecting and incorporating a tool for direct observation into a medical training program. We focus specifically on direct observation that occurs in clinical settings with actual patients. RESULTS Educators should focus on the existing tools for direct observation that have evidence of validity. Tool implementation must be a component of an educational program that includes faculty development about rating performance, providing meaningful feedback, and developing action plans collaboratively with learners. CONCLUSIONS Educators can enhance clinical skills education with strategic incorporation of tools for direct observation into medical training programs. Identification of a psychometrically sound instrument and attention to faculty development and the feedback process are critical to the success of a program of direct observation.
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Affiliation(s)
- Karen E Hauer
- Department of Medicine, University of California, San Francisco, CA 94143-0120, USA.
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8
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van Mook WNKA, van Luijk SJ, O'Sullivan H, Wass V, Schuwirth LW, van der Vleuten CPM. General considerations regarding assessment of professional behaviour. Eur J Intern Med 2009; 20:e90-5. [PMID: 19524166 DOI: 10.1016/j.ejim.2008.11.011] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2008] [Accepted: 11/16/2008] [Indexed: 10/21/2022]
Abstract
Core medical knowledge has been assessed for over fifty years and technical and communication skills for at least twenty. The assessment of professionalism however has failed to achieve recognition within this time frame. The interest in the assessment of professionalism and professional behaviour thus is a fairly recent development. This article will firstly clarify how professional behaviour assessment relates to other assessment methods using the framework proposed by Miller6. Thereafter a brief overview will be provided of the current "tool box" of methods available to assess professionalism. Data on the validity, reliability, feasibility, acceptability and educational utility of these "tools" as derived from published evidence will be reviewed. Subsequently a general overview of the way forward in the assessment of professionalism and professional behaviour will be given.
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Affiliation(s)
- Walther N K A van Mook
- Department of Intensive Care and Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
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9
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Al-Mahroos F. Construct Validity and Generalizability of Pediatrics Clerkship Evaluation at a Problem-Based Medical School, Bahrain. Eval Health Prof 2009; 32:165-83. [DOI: 10.1177/0163278709333149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The aim of this study is to identify the sources of construct validity evidence and determine generalizability of the scores given to medical students on pediatrics clerkship evaluation at the College of Medicine and Medical Sciences, Arabian Gulf University (CMMS-AGU). The CMMS-AGU is a problem-based medical school in Bahrain. The sample was composed of 140 students. Validity evidence and generalizability theory were sought. Results indicated that pediatrics clerkship evaluation at CMMS-AGU has content validity. Some limitations may have occurred in response process, but the students performance was observed directly by the tutors. There was evidence of range restriction and ``halo'' effect. Interrater reliability was 0.74, and the generalizability coefficient for three raters was 0.61. Students' contribution to the variance component of the global clerkship evaluation scores was 24%. Decision study indicated that seven tutors are required to achieve a generalizability coefficient of about 0.80. In conclusion, this study indicated that the pediatrics clerkship evaluation at the CMMS-AGU has, overall, some acceptable content and internal structure evidence of validity and that the raters are the major source of error. To improve the construct validity, there is a need to increase the number of raters and to train raters about the proper process of clerkship evaluation.
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Wilkinson TJ, Wade WB, Knock LD. A blueprint to assess professionalism: results of a systematic review. ACADEMIC MEDICINE : JOURNAL OF THE ASSOCIATION OF AMERICAN MEDICAL COLLEGES 2009; 84:551-8. [PMID: 19704185 DOI: 10.1097/acm.0b013e31819fbaa2] [Citation(s) in RCA: 161] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/16/2023]
Abstract
PURPOSE Assessing professionalism is hampered by varying definitions and these definitions' lack of a clear breakdown of the elements of professionalism into aspects that can be measured. Professionalism is multidimensional, so a combination of assessment tools is required. In this study, conducted during 2007-2008, the authors aimed to match assessment tools to definable elements of professionalism and to identify gaps where professionalism elements are not well addressed by existing assessment tools. METHOD The authors conducted literature reviews of definitions of professionalism and of relevant assessment tools, clustered the definitions of professionalism into assessable components, and clustered assessment tools of a similar nature. They then created a "blueprint" whereby the elements of professionalism are matched to relevant assessment tools. RESULTS Five clusters of professionalism were formed: adherence to ethical practice principles, effective interactions with patients and with people who are important to those patients, effective interactions with people working within the health system, reliability, and commitment to autonomous maintenance / improvement of competence in oneself, others, and systems. Nine clusters of assessment tools were identified: observed clinical encounters, collated views of coworkers, records of incidents of unprofessionalism, critical incident reports, simulations, paper-based tests, patients' opinions, global views of supervisor, and self-administered rating scales. CONCLUSIONS Professionalism can be assessed using a combination of observed clinical encounters, multisource feedback, patients' opinions, paper-based tests or simulations, measures of research and/or teaching activities, and scrutiny of self-assessments compared with assessments by others. Attributes that require more development in their measurement are reflectiveness, advocacy, lifelong learning, dealing with uncertainty, balancing availability to others with care for oneself, and seeking and responding to results of an audit.
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Hulsman RL. Shifting goals in medical communication. Determinants of goal detection and response formation. PATIENT EDUCATION AND COUNSELING 2009; 74:302-8. [PMID: 19135823 DOI: 10.1016/j.pec.2008.12.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2008] [Revised: 12/03/2008] [Accepted: 12/03/2008] [Indexed: 05/15/2023]
Abstract
OBJECTIVES Research and education of medical communication different perspective, making the extraction of clear recommendations from research that can be applied in education not always possible. In education, medical communication is encountered from a goal-oriented perspective, which is often lacking in quantitative research where the relationship between process variables and the content of medical practice is often ignored. The aim of this paper is to bring the worlds of research and education together by presenting a comprehensive model of determinants explaining the behavior of physicians in daily practice. A basic notion in this model is that medical communication is goal-oriented, problem-solving behavior. Goals in communication are not fixed, but permanently changing over time. Hence, communication abilities do not rely on behavioral skills only but also on perceptual skills in identifying goals. A number of determinants affect the cognitive processes of goal appraisal and response formation: knowledge, attitudes, social norms, self-efficacy, stressors and interfering goals. CONCLUSION Modeling medical communication as goal-oriented problem-solving behavior, and recognizing the complexity of goal appraisal and other key determinants of response formation may provide a common focus for both research and education in measuring, explaining and improving the HCP's behavior. PRACTICE IMPLICATIONS In education not only skill practicing but also reflection on the process and outcomes is important to understand how one acts in practice situations and should act in future situations. In research measurements should be expanded to take contextual and goal-oriented dimensions of the process of communication into account to make findings more relevant for education and practice.
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Affiliation(s)
- Robert L Hulsman
- Academic Medical Centre Amsterdam, Dept. of Medical Psychology, J3, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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Symons AB, Swanson A, McGuigan D, Orrange S, Akl EA. A tool for self-assessment of communication skills and professionalism in residents. BMC MEDICAL EDUCATION 2009; 9:1. [PMID: 19133146 PMCID: PMC2631014 DOI: 10.1186/1472-6920-9-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2008] [Accepted: 01/08/2009] [Indexed: 05/02/2023]
Abstract
BACKGROUND Effective communication skills and professionalism are critical for physicians in order to provide optimum care and achieve better health outcomes. The aims of this study were to evaluate residents' self-assessment of their communication skills and professionalism in dealing with patients, and to evaluate the psychometric properties of a self-assessment questionnaire. METHODS A modified version of the American Board of Internal Medicine's (ABIM) Patient Assessment survey was completed by 130 residents in 23 surgical and non-surgical training programs affiliated with a single medical school. Descriptive, regression and factor analyses were performed. Internal consistency, inter-item gamma scores, and discriminative validity of the questionnaire were determined. RESULTS Factor analysis suggested two groups of items: one group relating to developing interpersonal relationships with patients and one group relating to conveying medical information to patients. Cronbach's alpha (0.86) indicated internal consistency. Males rated themselves higher than females in items related to explaining things to patients. When compared to graduates of U.S. medical schools, graduates of medical schools outside the U.S. rated themselves higher in items related to listening to the patient, yet lower in using understandable language. Surgical residents rated themselves higher than non-surgical residents in explaining options to patients. CONCLUSION This appears to be an internally consistent and reliable tool for residents' self-assessment of communication skills and professionalism. Some demographic differences in self-perceived communication skills were noted.
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Affiliation(s)
- Andrew B Symons
- Department of Family Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Andrew Swanson
- Department of Family Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Denise McGuigan
- Department of Family Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Susan Orrange
- Graduate Medical Education, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Elie A Akl
- Department of Medicine and Department of Family Medicine, University at Buffalo School of Medicine and Biomedical Sciences, Buffalo, New York, USA
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Roberts C, Walton M, Rothnie I, Crossley J, Lyon P, Kumar K, Tiller D. Factors affecting the utility of the multiple mini-interview in selecting candidates for graduate-entry medical school. MEDICAL EDUCATION 2008; 42:396-404. [PMID: 18338992 DOI: 10.1111/j.1365-2923.2008.03018.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
CONTEXT We wished to determine which factors are important in ensuring interviewers are able to make reliable and valid decisions about the non-cognitive characteristics of candidates when selecting candidates for entry into a graduate-entry medical programme using the multiple mini-interview (MMI). METHODS Data came from a high-stakes admissions procedure. Content validity was assured by using a framework based on international criteria for sampling the behaviours expected of entry-level students. A variance components analysis was used to estimate the reliability and sources of measurement error. Further modelling was used to estimate the optimal configurations for future MMI iterations. RESULTS This study refers to 485 candidates, 155 interviewers and 21 questions taken from a pre- prepared bank. For a single MMI question and 1 assessor, 22% of the variance between scores reflected candidate-to-candidate variation. The reliability for an 8-question MMI was 0.7; to achieve 0.8 would require 14 questions. Typical inter-question correlations ranged from 0.08 to 0.38. A disattenuated correlation with the Graduate Australian Medical School Admissions Test (GAMSAT) subsection 'Reasoning in Humanities and Social Sciences' was 0.26. CONCLUSIONS The MMI is a moderately reliable method of assessment. The largest source of error relates to aspects of interviewer subjectivity, suggesting interviewer training would be beneficial. Candidate performance on 1 question does not correlate strongly with performance on another question, demonstrating the importance of context specificity. The MMI needs to be sufficiently long for precise comparison for ranking purposes. We supported the validity of the MMI by showing a small positive correlation with GAMSAT section scores.
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Affiliation(s)
- Chris Roberts
- Centre for Innovation in Professional Health Education and Research, Faculty of Medicine, University of Sydney, Sydney, New South Wales, Australia.
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14
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van Dulmen S, Tromp F, Grosfeld F, ten Cate O, Bensing J. The impact of assessing simulated bad news consultations on medical students' stress response and communication performance. Psychoneuroendocrinology 2007; 32:943-50. [PMID: 17689196 DOI: 10.1016/j.psyneuen.2007.06.016] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2007] [Revised: 06/27/2007] [Accepted: 06/27/2007] [Indexed: 11/23/2022]
Abstract
Seventy second-year medical students volunteered to participate in a study with the aim of evaluating the impact of the assessment of simulated bad news consultations on their physiological and psychological stress and communication performance. Measurements were taken of salivary cortisol, systolic and diastolic blood pressure, heart rate, state anxiety and global stress using a Visual Analogue Scale. The subjects were asked to take three salivary cortisol samples on the assessment day as well as on a quiet control day, and to take all other measures 5 min before and 10 min after conducting the bad news consultation. Consultations were videotaped and analyzed using the information-giving subscale of the Amsterdam Attitude and Communication Scale (AACS), the Roter Interaction Analysis System (RIAS), and the additional non-verbal measures, smiling, nodding and patient-directed gaze. MANOVA repeated measurements were used to test the difference between the cortisol measurements taken on the assessment and the control day. Linear regression analysis was used to determine the association between physiological and psychological stress measures and the students' communication performance. The analyses were restricted to the sample of 57 students who had complete data records. In anticipation of the communication assessment, cortisol levels remained elevated, indicating a heightened anticipatory stress response. After the assessment, the students' systolic blood pressure, heart rate, globally assessed stress level and state anxiety diminished. Pre-consultation stress did not appear to be related to the quality of the students' communication performance. Non-verbal communication could be predicted by pre-consultation physiological stress levels in the sense that patient-directed gaze occurred more often the higher the students' systolic blood pressure and heart rate. Post-consultation heart rate remained higher the more often the students had looked at the patient and the more information they had provided. However, the heart rate appeared to diminish the more often the students had reassured the patient. These findings suggest that in evaluating students' communication performance there is a need to take their stress levels into account.
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Affiliation(s)
- Sandra van Dulmen
- NIVEL (Netherlands Institute for Health Services Research), PO Box 1568, 3500 BN Utrecht, The Netherlands.
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15
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Lee AG, Beaver HA, Boldt HC, Olson R, Oetting TA, Abramoff M, Carter K. Teaching and Assessing Professionalism in Ophthalmology Residency Training Programs. Surv Ophthalmol 2007; 52:300-14. [PMID: 17472805 DOI: 10.1016/j.survophthal.2007.02.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The Accreditation Council for Graduate Medical Education (ACGME) has mandated that all residency training programs teach and assess new competencies including professionalism. This article reviews the literature on medical professionalism, describes good practices gleaned from published works, and proposes an implementation matrix of specific tools for teaching and assessing professionalism in ophthalmology residency. Professionalism requirements have been defined by the ACGME, subspecialty organizations, and other certifying and credentialing organizations. Teaching, role modeling, and assessing the competency of professionalism are important tasks in managing the ACGME mandate. Future work should focus on the field testing of tools for validity, reliability, feasibility, and cost-effectiveness.
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Affiliation(s)
- Andrew G Lee
- Department of Ophthalmology, University of Iowa Hospital and Clinics, Iowa City, Iowa 52242, USA
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Shankar RP, Dubey AK, Mishra P, Deshpande VY, Chandrasekhar TS, Shivananda PG. Student attitudes towards communication skills training in a medical college in Western Nepal. EDUCATION FOR HEALTH (ABINGDON, ENGLAND) 2006; 19:71-84. [PMID: 16531304 DOI: 10.1080/13576280500534693] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
CONTEXT Previous studies have shown that students have both positive and negative attitudes towards communication skills training. However, studies in Nepal are lacking. OBJECTIVES The present study was carried out to determine the positive and negative attitudes of student respondents using the previously validated communication skills attitude scale (CSAS) (see Appendix). METHODS The study was carried out among third- and fourth-semester students at the Manipal College of Medical Sciences, Pokhara, Nepal. These students are in the pre-clinical part of their course and learn the basic science subjects through an integrated, system-based curriculum. Gender, age, nationality of the respondents, occupation of parents, medium of instruction at school, attitude towards communication skills training during the clinical years, and self-rating of communication abilities were recorded. Association of the positive and negative attitudes with these variables was determined using appropriate statistical tests (p < 0.05). FINDINGS A total of 123 students participated in the study; 74 (60.2%) were male, and 104 (84.5%) had studied in English-medium schools. The median positive attitude score was 51 (inter-quartile range 7). Nationality and attitude towards communication skills training during the clinical years showed a significant association. The mean negative attitude scale score was 31.18 (SD = 4.96). A significant association was noted with attitude towards communication skills training during the clinical years. Both scales range from 13-65, with higher scores indicating stronger attitudes. CONCLUSIONS Communication skills training should be modified and strengthened. Formal courses during the clinical years are required. Training sessions for the faculty and further studies across different semesters and in different medical colleges in Nepal are needed.
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Affiliation(s)
- Ravi P Shankar
- Department of Pharmacology, Manipal College of Medical Sciences, Pokhara, Nepal.
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Hulsman RL, Mollema ED, Oort FJ, Hoos AM, de Haes JCJM. Using standardized video cases for assessment of medical communication skills: reliability of an objective structured video examination by computer. PATIENT EDUCATION AND COUNSELING 2006; 60:24-31. [PMID: 16332467 DOI: 10.1016/j.pec.2004.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2004] [Accepted: 11/15/2004] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Using standardized video cases in a computerized objective structured video examination (OSVE) aims to measure cognitive scripts underlying overt communication behavior by questions on knowledge, understanding and performance. In this study the reliability of the OSVE assessment is analyzed using the generalizability theory. METHODS Third year undergraduate medical students from the Academic Medical Center of the University of Amsterdam answered short-essay questions on three video cases, respectively about history taking, breaking bad news, and decision making. Of 200 participants, 116 completed all three video cases. Students were assessed in three shifts, each using a set of parallel case editions. About half of all available exams were scored independently by two raters using a detailed rating manual derived from the other half. Analyzed were the reliability of the assessment, the inter-rater reliability, and interrelatedness of the three types of video cases and their parallel editions, by computing a generalizability coefficient G. RESULTS The test score showed a normal distribution. The students performed relatively well on the history taking type of video cases, and relatively poor on decision making and did relatively poor on the understanding ('knows why/when') type of questions. The reliability of the assessment was acceptable (G = 0.66). It can be improved by including up to seven cases in the OSVE. The inter-rater reliability was very good (G = 0.93). The parallel editions of the video cases appeared to be more alike (G = 0.60) than the three case types (G = 0.47). DISCUSSION The additional value of an OSVE is the differential picture that is obtained about covert cognitive scripts underlying overt communication behavior in different types of consultations, indicated by the differing levels of knowledge, understanding and performance. The validation of the OSVE score requires more research. CONCLUSION AND PRACTICE IMPLICATIONS A computerized OSVE has been successfully applied with third year undergraduate medical students. The test score meets psychometric criteria, enabling a proper discrimination between adequately and poorly performing students. The high inter-rater reliability indicates that a single rater is permitted.
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Affiliation(s)
- R L Hulsman
- Department of Medical Psychology, J4, Academic Medical Centre, P.O. Box 22660, 1100 DD Amsterdam, The Netherlands.
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De Haes JCJM, Oort FJ, Hulsman RL. Summative assessment of medical students' communication skills and professional attitudes through observation in clinical practice. MEDICAL TEACHER 2005; 27:583-9. [PMID: 16332548 DOI: 10.1080/01421590500061378] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
UNLABELLED To establish medical students' professional competence for the medical profession, we designed a standardized observation procedure and the Amsterdam Attitude and Communication Scale (AACS) with nine five-point scale items, for summative assessment of their communication skills and professional attitudes. This study examines the reliability of the AACS assessment in clinical practice. In the Academic Medical Centre, Amsterdam, The Netherlands, the performance of 442 fifth year clinical students was judged six times in two settings: behaviour in clinical practice was judged independently twice by a doctor and a nurse; one videotaped patient interview was judged independently by a doctor and by a psychologist. The final mark was obtained by averaging ratings across all six assessments. Raters were 88 doctors, 29 nurses, and three psychologists. MAIN OUTCOME MEASURES Standard errors (SEs) for absolute judgements indicate measurement precision. Precision of AACS scores is considered sufficient with SEs smaller than 0.25. Multi-disciplinary assessment of students' clinical performance using the AACS is feasible and sufficiently precise (with an overall mean of 3.97 and standard deviation of 0.55, the absolute SE is 0.21). Judgements of behaviour in the clinic were more precise (SEs range from 0.11 to 0.16) than judgements of videotaped interviews (SEs are 0.25 and 0.29). The procedure is sufficiently precise if five or six assessments are combined.
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Affiliation(s)
- J C J M De Haes
- Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, The Netherlands
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Cannings R, Hawthorne K, Hood K, Houston H. Putting double marking to the test: a framework to assess if it is worth the trouble. MEDICAL EDUCATION 2005; 39:299-308. [PMID: 15733166 DOI: 10.1111/j.1365-2929.2005.02093.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND It is a challenge to assign a mark that accurately measures the quality of students' work in essay-type assessments that require an element of judgement and fairness by the markers. Double marking such assessments has been seen as a way of improving the reliability of the mark. The analysis approach often taken is to look for absolute agreement between markers instead of looking at all aspects of reliability. AIM To develop an analytic process that will examine the components and meanings of reliability calculations that can be used for assessing the value of double marking a piece of work. METHODS An undergraduate case study assessment in General Practice was used as an illustration. Datasets of double marking were collected retrospectively for 1999-2000, and prospectively for 2002-03. An assessment of intermarker agreement and its effect on the reliability of the final mark for students was made, using methods dependent on the type of data collected and Generalisability Theory. RESULTS AND CONCLUSIONS The data were used to illustrate how to interpret the results of Bland and Altman plots, anova tables and Cohen's kappa calculations. Generalisability Theory was used to show that, while there was reasonable agreement between markers, the reliability of the mark for the student was still only moderate, probably due to unexplained variability elsewhere in the process. Possible reasons for this variability are discussed. A flowchart of the decisions and actions needed to judge whether a piece of work should be double marked has been constructed.
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Affiliation(s)
- Rebecca Cannings
- Department of General Practice, University of Wales College of Medicine, Cardiff, UK
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Hulsman RL, Mollema ED, Hoos AM, de Haes JCJM, Donnison-Speijer JD. Assessment of medical communication skills by computer: assessment method and student experiences. MEDICAL EDUCATION 2004; 38:813-824. [PMID: 15271041 DOI: 10.1111/j.1365-2929.2004.01900.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND A computer-assisted assessment (CAA) program for communication skills designated ACT was developed using the objective structured video examination (OSVE) format. This method features assessment of cognitive scripts underlying communication behaviour, a broad range of communication problems covered in 1 assessment, highly standardised assessment and rating procedures, and large group assessments without complex organisation. SETTING The Academic Medical Centre (AMC) at the University of Amsterdam, the Netherlands. Aims To describe the development of the AMC Communication Test (ACT); to describe our experiences with the examination and rating procedures; to present test score descriptives, and to present the students' opinions of ACT. DESIGN The ACT presents films on history taking, breaking bad news and shared decision making. Each film is accompanied by 3 types of short essay questions derived from our assessment model: "knows", "knows why/when" and "knows how". Evaluation questions about ACT were integrated into the assessment. Participants A total of 210 third year medical undergraduates were assessed. This study reports on the 110 (53%) students who completed all evaluation questions. RESULTS Marking 210 examinations took about 17 days. The test score matched a normal distribution and showed a good level of discrimination of the students. About 75% passed the examination. Some support for the validity of our assessment model was found in the students' differential performance on the 3 types of questions. The ACT was well received. Student evaluations confirmed our efforts to develop realistic films that related well to the communication training programme. CONCLUSIONS The ACT is a useful assessment method which complements interpersonal assessment methods for the evaluation of the medical communication skills of undergraduates.
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Affiliation(s)
- R L Hulsman
- Department of Medical Psychology J4, Academic Medical Centre, PO Box 22660, 1100 DD Amsterdam, The Netherlands.
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