Assessing verbal communication skills of medical students
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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:

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Assessing verbal communication skills of medical students

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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

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

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


Assessing verbal communication skills of medical students

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

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

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


Methods1

Methods

  • Assessment tool:

    • 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

  • Raters:

    • 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

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 item1

Results: Distribution of score by item


Results distribution of score by item2

Results: Distribution of score by item


Agreement between raters

Agreement between raters

  • Agreement for items that had marginal homogeneteity (Cohen’s weighted Kappa index for ordinal data, 95% confidence interval)


Discussion

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 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

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

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 Disorders176(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


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