Assessing communication skills of GP registrars: a comparison of patient and GP examiner ratings

CONTEXT: General practice. OBJECTIVES: To compare ratings of GP registrars' communication skills by patients and GP examiners. DESIGN: A comparative study where the communication skills of GP registrars were assessed both by patients, using a validated tool called the Doctors' Interpersonal Skills Questionnaire (DISQ), and by GP examiners as part of the Fellowship examination of the Royal Australian College of General Practitioners (RACGP). PARTICIPANTS: These included 138 GP registrars, 6075 patients, and more than 70 GP examiners. RESULTS: Spearman rank correlations were used to test the strength of the relationship between Fellowship examination and DISQ scores. Findings showed that there were several communication skills areas with mild (but significant) correlations between patient and GP examiner ratings. These areas included warmth of greeting, listening skills, respect, and concern for the patient as a person. No significant correlations were detected for explanation skills. Interestingly, the correlations between GP examiner and patient ratings were stronger for female GP registrars. CONCLUSION: There is some evidence that patients' ratings of GP registrars' communication skills is aligned to ratings made by GP examiners as part of the summative RACGP Fellowship examination. However, further work is required to assess the strength of this alignment, given that patient-doctor communication is assessed more widely through new components of the examination.     

A modified essay question evaluation of pre-clinical teaching of communication skills

This paper describes the use of a modified essay question to investigate the nature of certain cognitive changes associated with some quite specific preclinical teaching. Although the teaching was aimed at developing communication skills, it appeared to draw attention to some broader aspects of health and the role of the general practitioner. The MEQ indicated that a number of important changes appeared to be associated with the teaching experience.     

Workshops for consultants on the teaching of clinical communication skills

Summary. A group of senior medical school staff concerned about the short-lived effects of communication training formed the Medical Interview Teaching Association. They felt that communication training needed to be reinforced throughout the curriculum and that this would need active involvement by large numbers of consultants. To achieve this they planned a series of workshops. Seventeen consultants and eight other senior staff agreed to participate in the pilot workshop. This was a 3 1/2-day residential workshop. The structure was adapted from a ‘faculty development’ model used successfully in the USA. Participants worked mostly in small groups helped by experienced facilitators. The teaching style was learner centred and therefore the details of the problem-based agenda and the choice of working methods were largely determined by the participants themselves. There were also some conventional lectures and demonstrations. Evaluation was by postal questionnaire 2 weeks later. This requested both qualitative comments and Likert scale ratings about every aspect of process and outcome. Most responses were strongly positive. Participants felt they made good progress in developing new skills and new curriculum ideas. They also felt more motivated and self-aware as teachers. The learner-centred approach and the diversity of learning activities were seen as very useful. The unstructured approach to self-awareness training was felt to be less useful. It is concluded that such workshops could well lead to more effective communication training and may also have wider implications for medical education.     

A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Summary. Teaching preclinical medical students about doctor-patient communication gives them an opportunity to develop their interviewing skills prior to their having to elicit lists of symptoms in their clinical years. General practitioners should be among the more efficient interviewers in clinical medicine and therefore able to make important contributions to the teaching of interviewing skills. This paper describes the aims, objectives and methods of the preclinical communications skills course at St George's Hospital Medical School. The contribution of the Division of General Practice and Primary Care to the teaching of interviewing skills in the preclinical course has been evaluated using rapid group methods. Students were asked to identify examples of specific interviewing behaviours in videotaped general practice consultations, and to judge whether the behaviours were helpful or unhelpful in eliciting relevant information from the patient. Students who had been given experience in interviewing patients in small groups led by general practitioners identified significantly more helpful and unhelpful interviewing behaviours in the taped consultations than students who had not received the small-group teaching. Students rated the teaching as relevant and effective in terms of giving insights into the interviewing skills they needed to develop. Group methods of evaluation such as these might prove useful to other medical schools with class sizes of 150 students or more.     

Preliminary evaluation of "interpreter" role plays in teaching communication skills to medical undergraduates

RATIONALE AND OBJECTIVES: Multiculturalism presents linguistic obstacles to health care provision. We explored the early introduction of "interpreter" role-play exercises in teaching medical undergraduates communication skills. The interpreter role creates a natural barrier in communication providing an active prompt for recognizing learning needs in this area. METHODS: Bilingual Cantonese first-year medical students (n=160) were randomly allocated to either "Observer" or "Interpreter" role plays at a small-group introductory communication skills workshop using a quasi experimental design, counterbalanced across tutors. Students assessed their own skill competence before and, together with their perceptions of the different role plays' effectiveness, again after the workshop, using an anonymous 16 item Likert-type scale, analysed using ANOVA and MANOVA. RESULTS: Students' assessments of their skills improved significantly following the workshop (F=73.19 [1,156], P=0.0009). Students in the observer group reported greater changes in their scores following the workshop than did students in the interpreter group (F=4.84 [1,156], P=0.029), largely due to improvement in perceived skill (F=4.38 [1,156], P=0.038) rather than perceived programme effectiveness (F=3.13 [1,156], P > 0.05). Subsequent MANOVA indicated no main effect of observer/interpreter conditions, indicating these differences could be attributed to chance alone (F=1.41 [16 141], P > 0.05). CONCLUSION: The workshop positively influenced students' perceived communication skills, but the "Interpreter" role was less effective than the "Observer" role in achieving this. Future studies should examine whether interpreter role plays introduced later in the medical programme are beneficial.     

The curriculum of communication skills teaching at Maastricht Medical School

In the Skillslab at Maastricht Medical School students are prepared for their first encounters with patients. Students can focus on individual skills, separately mastering each skill in a controlled systematic manner. With this foundation students are better equipped to face the complex intellectual and emotional demands of real patients. A large proportion of training concerns communication skills. Features of Skillslab communication skills training programme are: (1) its continuity (once every 2 weeks, from year 1 to year 6); (2) a gradual increase of complexity in skills (basic interview skills, phases of interviews, entire interviews, problem patients); (3) a gradual increase of complexity in practice situations (apparatus, role-playing, simulated patients, real patients). Evaluation shows students' and teachers' satisfaction with the programme. Comparison with conditions required for interpersonal skills training shows that these are fully met. However, there are drawbacks, which are described.     

The teaching of communication skills in United Kingdom medical schools

A survey was carried out of the teaching of communication skills in medical schools in the United Kingdom during the academic year 1989/90. Comparison with previous surveys shows a considerable development over the last 10 years. Departments of psychiatry and general practice continue to play a major part in such teaching. There was wide variation in educational objectives and in the curricular time available. Concern is expressed about the methods of assessment and the degree of integration between departments. Future plans and the perceived barriers are reported and the implications discussed.     

Portfolio use in general practice vocational training: a survey of GP registrars

BACKGROUND: Portfolios are increasingly advocated in medical education. Qualitative studies have suggested their value in stimulating experiential learning, promoting deep learning and encouraging reflection. This study explored the use of educational portfolios in reflective learning by general practice (GP) registrars in Yorkshire, England. METHOD: A postal questionnaire was sent to the 92 registrars of a deanery in November 2001, after a pilot study with registrars in a single district had been carried out. The questionnaire explored the registrars' use of the portfolio to collect information and for reflection, as well as registrars' attitudes towards the portfolio. It was returned by 71 registrars, representing a 77% response rate. Structured in-depth interviews were used to support the results obtained. RESULTS: Of the registrars who responded, 65% recorded information on a regular basis and 42% used the portfolio in reflective learning. Experienced registrars used the portfolio least. Those with supportive trainers used the portfolio more in reflection. CONCLUSIONS: The study suggests that the role of the trainer/supervisor is vital in portfolio-based learning. It raises questions about the acceptability of portfolio learning. It adds weight to the suggestion that careful introduction of portfolios and training of supervisors is vital. Further work to establish the role of portfolios in reflective learning is recommended.     

Effective teaching of communication skills for medical practice: selecting an appropriate clinical context

Increasingly, courses in communication skills are being incorporated into medical training. In order for communication skills to be effectively maintained in post-training medical practice, they must be taught within an appropriate clinical context. The present paper describes and provides rationale for seven criteria by which to select clinical issues which are appropriate foci for communication skills courses. The criteria are : (1) the issue must be one which is encountered frequently in clinical practice; (2) the issue must be associated with a high burden of illness; (3) there must be evidence that practitioners need to improve skills for dealing with the issue; (4) there must be an intervention, of which communication skills are an integral component, that is demonstrably effective for dealing with the clinical issue; (5) the intervention must represent a cost-effective means of dealing with the issue; (6) the intervention must be acceptable to doctors and be able to be incorporated into routine medical practice; (7) the intervention must be acceptable to patients. Examples of clinical issues which fit these criteria are given in the paper and include smoking, hazardous alcohol consumption, non-adherence to treatment instructions, overdue cervical screening, inappropriate diet, recovery from medical interventions, and breaking bad news to patients.     

Breaking bad news: medical undergraduate communication skills teaching and learning

Summary. Teaching on the theme of 'breaking bad news' was selected for special development as part of an introductory course on communication skills for preclinical medical students in 1987. Eight parents of handicapped children and three patients terminally ill with neoplastic diseases cooperated in a series of semi-structured group discussions in which students were encouraged to interact with patients and children. The patients/parents readily assumed the role of teachers and where it was possible, they participated in similar sessions the following year.
Analysis of questionnaires indicated that the plan had proved acceptable to patients, relatives and students. Follow-up of student opinion one year later indicated that students felt they had derived benefit from these opportunities to learn first-hand from patients and parents of handicapped children.