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

‘You are not alone.’ An exploratory study on open-topic, guided collaborative reflection sessions during the General Practice placement

Background: To support professional development of medical students faced with challenges of the clinical phase, collaborative reflection sessions (CRSs) are used to share and reflect on workplace experiences. Facilitation of CRSs seems essential to optimise learning and to provide important skills for lifelong learning as a professional. However, little is known about which workplace experiences students share in CRSs without advance guidance on specific topics, and how reflecting on these experiences contributes to students’ professional development. Therefore, we explored which workplace experiences students shared, what they learned from reflection on these experiences, and how they perceived the value of CRSs. Methods: We conducted an exploratory study among medical students (N = 99) during their General Practice placement. Students were invited to openly share workplace experiences, without pre-imposed instruction. A thematic analysis was performed on shared experiences and student learning gains. Students’ perceptions of CRSs were analysed using descriptive statistics. Results: All 99 students volunteered to fill out the questionnaire. We found four themes relating to students’ shared experiences: interactions with patients, complex patient care, diagnostic or therapeutic considerations, and dealing with collegial issues. Regarding students’ learning gains, we found 6 themes: learning from others or learning from sharing with others, learning about learning, communication skills, self-regulation, determination of position within the healthcare team, and importance of good documentation. Students indicated that they learned from reflection on their own and peer’s workplace experiences. Students valued the CRSs as a safe environment in which to share workplace experiences and helpful for their professional development. Conclusions: In the challenging General Practice placement, open-topic, guided CRSs provide a helpful and valued learning environment relevant to professional development and offer opportunities for vicarious learning among peers. CRSs may also be a valuable tool to incorporate into other placements.</p

On n-partite tournaments with unique n-cycle

Communication assessment in real-life consultations is a complex task. Generic assessment instruments help but may also have disadvantages. The generic nature of the skills being assessed does not provide indications for context-specific behaviour required in practice situations; context influences are mostly taken into account implicitly. Our research questions are: 1. What factors do trained raters observe when rating workplace communication? 2. How do they take context factors into account when rating communication performance with a generic rating instrument? Nineteen general practitioners (GPs), trained in communication assessment with a generic rating instrument (the MAAS-Global), participated in a think-aloud protocol reflecting concurrent thought processes while assessing videotaped real-life consultations. They were subsequently interviewed to answer questions explicitly asking them to comment on the influence of predefined contextual factors on the assessment process. Results from both data sources were analysed. We used a grounded theory approach to untangle the influence of context factors on GP communication and on communication assessment. Both from the think-aloud procedure and from the interviews we identified various context factors influencing communication, which were categorised into doctor-related (17), patient-related (13), consultation-related (18), and education-related factors (18). Participants had different views and practices on how to incorporate context factors into the GP(-trainee) communication assessment. Raters acknowledge that context factors may affect communication in GP consultations, but struggle with how to take contextual influences into account when assessing communication performance in an educational context. To assess practice situations, raters need extra guidance on how to handle specific contextual factors

What do we know about written assessment of health professionals’ communication skills? A scoping review

Objective - The aim of this scoping review was to investigate the published literature on written assessment of communication skills in health professionals’ education. Methods - Pubmed, Embase, Cinahl and Psychnfo were screened for the period 1/1995–7/2020. Selection was conducted by four pairs of reviewers. Four reviewers extracted and analyzed the data regarding study, instrument, item, and psychometric characteristics. Results - From 20,456 assessed abstracts, 74 articles were included which described 70 different instruments. Two thirds of the studies used written assessment to measure training effects, the others focused on the development/validation of the instrument. Instruments were usually developed by the authors, often with little mention of the test development criteria. The type of knowledge assessed was rarely specified. Most instruments included clinical vignettes. Instrument properties and psychometric characteristics were seldom reported. Conclusion - There are a number of written assessments available in the literature. However, the reporting of the development and psychometric properties of these instruments is often incomplete. Practice implications written assessment of communication skills is widely used in health professions education. Improvement in the reporting of instrument development, items and psychometrics may help communication skills teachers better identify when, how and for whom written assessment of communication should be used

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

Contains fulltext : 97982.pdf (postprint version ) (Open Access)ABSTRACT: 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

: OSCEology‐ unresolved questions and major challenges

Rationale: The OSCE has become one of the most important assessment methods of health professionals’ communication. Although the format has been used for almost forty years, there are still unsolved questions. This symposium will enable five key challenges to be explored from a variety of perspectives. Presentations: Each presentation will address a selection of the following: 1) Should communication skills be assessed together with other clinical skills or separately? 2) Are detailed checklists better than global ratings? 3) What is the role of feedback? 4) What is adequate in examiner training? 5) Is the money spent worth the effort and impact on students’ learning? Presentation 1: Jonathan Silverman; University of Cambridge School of Clinical Medicine; Cambridge Biomedical Campus, Hills Road, Cambridge CB2 0SP;   [email protected] The Simulated Clinical Encounter Examination is a high stakes finals 10‐station 100 minute OSCE which integrates content, process and clinical reasoning in simulated patient encounters. Experiences with integration, rating scales and particularly major issues with feedback will be highlighted. Comparisons will be made with other UK OSCEs visited as an external examiner to demonstrate the importance of station and circuit design and length Presentation 2: Marc van Nuland; Department of General Practice, University of Leuven, Belgium; [email protected] The 10‐station communication skills OSCE is a high stakes final exam in the 4th master for students having chosen to start General Practice vocational training. Experiences with global versus checklist rating scales, provision of narrative feedback and cost issues related to this OSCE will be discussed in the light of optimizing the utility of the OSCE. Presentation 3: Sabine Feller; Institute of Medial Education, University of Bern, Faculty of Medicine; Konsumstrasse 13, CH‐3010 Bern;   [email protected] The Swiss national licencing exam for candidates entering postgraduate training is a 12‐station OSCE which integrates clinical and communication skills in simulated patient encounters. Experiences with assessment of communication skills together with other clinical skills, with generic rating scales, length of examiner training and the impact on students' learning will be presented. Presentation 4: Claudia Kiessling, Institute for Medical Education, University of Munich; Ziemssenstr. 1; D‐80336 München, Germany; [email protected]‐muenchen.de A cross‐sectional online‐survey investigated the use of different assessment methods for communication skills in undergraduate medical education in Germany, Austria, and Switzerland. Results indicate that OSCEs are widely used. Approaches concerning the separation or integration with clinical skills, average number of stations, use of rating schemes, and different outlines of examiner trainings will be presented.status: publishe

“Now, let’s assess communication skills!” – How to integrate assessment into your communication skills curriculum

Rationale: Communication skills training has become increasingly integrated into the education of health care professionals (e.g. physicians, nurses, physiotherapists, pharmacists, etc.). In addition to teaching communication skills, there are important reasons to assess the extent to which students and vocational trainees have acquired these skills. Research evidence supports the need to integrate assessment longitudinally within the whole curriculum. The purpose of this workshop is to explore the factors that must be taken into consideration in order to effectively integrate assessment of communication skills within health professional curricula. Objectives: After this session participants will be (more) able to: 1) Evaluate their communication curriculum according to the pyramid of maturity of communication curricula (Silverman, 2009) and clarify the objectives and the outline of their teaching; 2) Reflect on the integration of assessments into their communication curricula 3) Consider opportunities for improvement to achieve an integrated longitudinal communication curriculum 4) Clarify important notions related to assessment like ‘blueprinting’, ’formative versus summative assessment’, ‘valid and reliable assessment instruments’, ‘context specificity’, ‘ patient feedback’, ‘standard setting’, ‘overall assessment plan’, etc. Session format/activities: The workshop starts with clarifying the workshop objectives and participants’ expectations. Then, participants are asked to evaluate in pairs where their curriculum would be in the pyramid of maturity of communication curricula and to discuss the relevance of assessment in their curriculum. For each of the steps in the pyramid the role of assessment can be clarified, making curriculum development goals more evident. Then small groups are formed according to the steps in the pyramid. Participants will discuss why they put themselves there, what their teaching looks like, and what and how they assess. In a next step they are asked to make an inventory of the most important issues and bottlenecks concerning the integration of assessments into communication curricula. Further small group discussions will look at what each needs to proceed to the next step in the pyramid, which are their priorities and which are their realistic goals taking participants’ specific context into regard. In a final plenary session ideas and solutions will be shared and synthesized into take‐home messages.status: publishe

Patient complaints in general practice seen through the lens of professionalism:a retrospective observational study

BACKGROUND: Professionalism is a key competence for physicians. Patient complaints provide a unique insight into patient expectations regarding professionalism. Research exploring the exact nature of patient complaints in general practice, especially focused on professionalism, is limited. AIM: To characterise patient complaints in primary care and to explore in more detail which issues with professionalism exist. DESIGN & SETTING: A retrospective observational study in which all unsolicited patient complaints to a representative out-of-hours general practice (OOH GP) service provider in The Netherlands were analysed over a 10-year period (2009–2019). METHOD: Complaints were coded for general characteristics and thematically categorised using the CanMEDS Physician Competency Framework (CanMEDS) as sensitising concepts. Complaints categorised as professionalism were subdivided using open coding. RESULTS: Out of 746 996 patient consultations (telephone, face-to-face, and home visits) 484 (0.065%) resulted in eligible complaint letters. The majority consisted of two or more complaints, resulting in 833 different complaints. Most complaints concerned GPs (80%); a minority (19%) assistants. Thirty-five per cent concerned perceived professionalism lapses of physicians. A rich diversity in the wording of professionalism lapses was found, where ' not being taken seriously ' was mentioned most often. Forty-five per cent related to medical expertise, such as missed diagnoses or unsuccessful clinical treatment. Nineteen per cent related to management problems, especially waiting times and access to care. Communication issues were only explicitly mentioned in 1% of the complaints. CONCLUSION: Most unsolicited patient complaints were related to clinical problems. A third, however, concerned professionalism issues. Not being taken seriously was the most frequent mentioned theme within the professionalism category