Assessing verbal communication skills of medical students
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Transcript Assessing verbal communication skills of medical students
Assessing verbal
communication skills
of medical students
J Voges
E Jordaan *
L Koen
DJH Niehaus
Department of Psychiatry, University of Stellenbosch and
Stikland Hospital
* Biostatistics Unit: Medical Research Council, Bellville
Positioning of the study
Large project:
Correlation
of communication skills with
academic performance of medical students
Sub-studies:
Facial
affect recognition
Oral examination marks in psychiatry
Non-verbal communication skills
Verbal communication skills
Introduction
Communication is one of six required
competencies identified by the ACGME
Effective communication associated with:
Improved
patient and doctor satisfaction
Treatment compliance
Strong predictor of medical school success
Assessment of communication skills is
complex and difficult to implement
Aim
First phase:
To evaluate the usability of the Liverpool
Communication Skills Assessment Scale for
assessing the communication skills of medical
students of the University of Stellenbosch
Second phase:
To determine effectiveness of undergraduate
medical students’ communication skills using the
Liverpool Communication Skills Assessment
Scale
To determine if there is a correlation between
communication skills and overall academic
performance
Measurement equivalence
Central issue in determining the
applicability of instrument cross-nationally
and cross-culturally
Factors to consider:
Content
equivalence
Semantic equivalence
Technical equivalence
Criterion equivalence
Conceptual equivalence (Flaherty et al, 1988)
Methods
Subjects:
Medical
students completing late rotation
5 min. semi-structured interview with patient
that was videotaped
Permission granted by Faculty of Health
Sciences and Ethics committee of SU
Venue:
5-week
Psychiatry rotation at Stikland hospital
Methods
Assessment tool:
Raters:
Liverpool Communication Skills Assessment Scale (LCSAS)
Consists of 12-items measuring several aspects of
communication
Mixed method of using both a checklist and a rating approach
4-point ordinal rating scale ranging from Unacceptable to Good
Ease of use, acceptable reliability
2 independent raters, additional training
Third rater included, instruction given
Help sheet with additional descriptors to guide scoring
Primary statistical evaluation:
Inter-rater reliability
Marginal homogeneity (Chi-square statistic, p-value<0.01 as
significant)
Agreement (Cohen’s weighted Kappa index for ordinal data)
Results: Distribution of score by rater
Intra-class correlation coefficient = 0.8 (0.71-0.87)
Results: Distribution of score by item
Results: Distribution of score by item
Results: Distribution of score by item
Agreement between raters
Agreement for items that had marginal homogeneteity
(Cohen’s weighted Kappa index for ordinal data, 95%
confidence interval)
Items
Rater 1 vs. Rater 2
Rater 1 vs. Rater 3
Item 1: Greeting
0.71 (0.52-0.91)
0.54 (0.33-0.75)
0.57 (0.38-0.77)
Item 2:
Introduction
0.76 (0.63-0.70)
0.79 (0.66-0.92)
0.92 (0.83-1.00)
Item 4: Eye-contact 0.66 (0.41-0.91)
0.38 (0.10-0.65)
0.69 (0.47-0.91)
Item 8: Questions
0.37 (0.14-0.60)
0.55 (0.37-0.74)
0.62 (0.43-0.81)
Rater 2 vs. Rater3
Discussion
LCSAS evaluated for usability to measure
communication skills in medical students
Additional training
Inclusion of additional rater and help sheet
Total score: high level of correlation
Inter-rater reliability
Marginal homogeneity
4 of 12 items
Agreement
Additional training – greater agreement
Reliability of measure:
Continue with development and standardisation of assessment
scale for use in South Africa
Training
Limitations and future directions
Limitations:
Small
sample
Inter-rater reliability
Marginal homogeneity and agreement
Training
Future directions:
Re-evaluation
of the scoring categories to
promote understanding
Language
Gender
Culture
Conclusion
Use of LCSAS in South African setting
Correlation for total score
Training necessary to improve agreement
for each item
Further development necessary
Use in education context of South Africa
by various health professionals
Selected references
Epstein, R.M. Campbell, T.L., Cohen-Cole, S.A., McWhinney,
I.R. & Smilkstein, G. (1993). Perspectives on patient-doctor
communication. Journal of Family Practice 37(4): 377–388.
Flaherty, J.A., Gaviria, F.M., Pathak, D., et al. (1988). Developing
instruments for cross-cultural psychiatry needs. Journal of
Nervous and Mental Disorders 176(5): 257-263.
Humphris, G.M. & Kaney, S. (2001). The Liverpool Brief
Assessment System for Communication Skills in the Making of
Doctors. Advances in Health Sciences Education 6: 69–80.
Parker, G. (1993). On our selection: predictors of medical school
success. Medical Journal of Australia 158(11): 747–751.
Project supported by funding from FINLO
Faculty of Health Sciences