Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

BACKGROUND Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication. METHODS A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour. RESULTS We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors. CONCLUSIONS Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.We also thank the Dutch Ministry of Health for funding the collection and videotaping of routine GP consultations

Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

BACKGROUND Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account. METHODS We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests. RESULTS In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p<0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17. CONCLUSIONS Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.The study was funded by the SBOH Foundation, employer of Dutch Family Medicine Residents and funder of the national residency program for GPs in the Netherlands

ACCOUNTING IN CONTEXT OF COMMUNICATION, LANGUAGE, AND INFORMATION

Accounting at various times has been referred to as a communication process, a language, and a conveyor of information. Given this condition, an analysis of accounting in terms of the theories relating to those references would enable an understanding of: (1) how well the parts of accounting conform with language theory; (2) how communication theory can aid in the clarification and improvement of the accounting communication process; and (3) how relevant is information theory for the refinement of accounting information. This study is a partial analysis which presents some implications of those theories for accounting.information theory, financial analysis, behavior patterns, financial statements, structure assignment algorithm, predictability, information content, entropy.

Inter-satellite Quantum Key Distribution at Terahertz Frequencies

Terahertz (THz) communication is a topic of much research in the context of high-capacity next-generation wireless networks. Quantum communication is also a topic of intensive research, most recently in the context of space-based deployments. In this work we explore the use of THz frequencies as a means to achieve quantum communication within a constellation of micro-satellites in Low-Earth-Orbit (LEO). Quantum communication between the micro-satellite constellation and high-altitude terrestrial stations is also investigated. Our work demonstrates that THz quantum entanglement distribution and THz quantum key distribution are viable deployment options in the micro-satellite context. We discuss how such deployment opens up the possibility for simpler integration of global quantum and wireless networks. The possibility of using THz frequencies for quantum-radar applications in the context of LEO deployments is briefly discussed.Comment: 7 pages, 6 figure

Language and Culture in Relation to Intercultural Communication in a Business Context

Intercultural communication; that is, face-to-face communication between people from different cultural background, often has hindrances because of some factors such as the vocabulary, the discourse pattern and the concept of time. Thus, this paper will analyze how these factors can hinder the intercultural communication between the Asians and Americans and what might become the result of the intercultural miscommunication, especially in business contexts

Radio Link Enabler for Context-aware D2D Communication in Reuse Mode

Device-to-Device (D2D) communication is considered as one of the key technologies for the fifth generation wireless communication system (5G) due to certain benefits provided, e.g. traffic offload and low end-to-end latency. A D2D link can reuse resource of a cellular user for its own transmission, while mutual interference in between these two links is introduced. In this paper, we propose a smart radio resource management (RRM) algorithm which enables D2D communication to reuse cellular resource, by taking into account of context information. Besides, signaling schemes with high efficiency are also given in this work to enable the proposed RRM algorithm. Simulation results demonstrate the performance improvement of the proposed scheme in terms of the overall cell capacity

Preserving Communication Context. Virtual workspace and interpersonal space in Japanese CSCW.

The past decade has seen the development of a perspective\ud holding that technology is socially constructed (Mackenzie and Wacjman, 1985; Bijker, Hughes and Pinch, 1987; Bijker and Law, 1992). This paper examines the social construction of one group of technologies, systems for computer supported cooperative work (CSCW). It describes the design of CSCW in Japan, with particular attention to the influence of culture on the design process. Two case studies are presented to illustrate the argument that culture is an important factor in technology design, despite commonly held assumptions about the neutrality and objectivity of science and technology. The paper further argues that, by looking at\ud CSCW systems as texts which reflect the context of their production and the society from which they come, we may be better able to understand the transformations that operate when these texts are “read” in the contexts of their implementation

Repeat and first time visitation in an experience specific context: The Valley of the Giants Tree Top Walk.

Communication with the public is a primary consideration in the design of natural area tourist attractions (Manfredo & Bright,1991; Roggenbuck, 1992; Vogt & Stewart, 1998). In a management context, communication is essential in ensuring a relevant and enjoyable experience on the part of the visiting tourists (Magill, 1995). Communication also serves as an important management aid in reminding visitors of appropriate behaviour while ensuring continued visitor interest in the attraction (Moscardo, 1998; Moscardo & Woods,2001). This paper presents the results of a .survey examining motivations and attitudes of repeat and first time visitors to the Tree Top Walk site in the context of the communication strategy used at the site

A principled information valuation for communications during multi-agent coordination

Decentralised coordination in multi-agent systems is typically achieved using communication. However, in many cases, communication is expensive to utilise because there is limited bandwidth, it may be dangerous to communicate, or communication may simply be unavailable at times. In this context, we argue for a rational approach to communication --- if it has a cost, the agents should be able to calculate a value of communicating. By doing this, the agents can balance the need to communicate with the cost of doing so. In this research, we present a novel model of rational communication that uses information theory to value communications, and employ this valuation in a decision theoretic coordination mechanism. A preliminary empirical evaluation of the benefits of this approach is presented in the context of the RoboCupRescue simulator