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1.
Jonathan Silverman Julian ArcherSusan Gillard Rachel HowellsJohn Benson 《Patient education and counseling》2011,82(1):89-93
Objective
To evaluate the content validity, internal consistency and generalisability of EPSCALE, a new rating scale to measure communication skills in explanation and planning.Methods
Content validity: consensus exercise and expert review. Internal consistency and generalisability: 124 clinical students undertaking 4 OSCE stations with simulated patients, with one observer (hospital specialist, GP or communication specialist) per station, during finals examinations. Internal consistency estimated by coefficient alpha, generalisability estimated by generalisability coefficient and variance components using EPSCALE.Results
Content validity was supported by consensus exercise and expert review. Internal consistency was high with a coefficient alpha of greater than 0.8 for all four explanation and planning stations in the finals exam. Generalisability coefficient for 4 OSCE stations was 0.50.Conclusions
This paper provides initial evidence that EPSCALE has content validity and high internal consistency when used to assess explanation and planning skills in the consultation. It defines the generalisability of this new rating scale. Further work is needed to explore the scale's validity by a range of other measures. 相似文献2.
Lauren G. Collins Anne SchrimmerJames Diamond Janice Burke 《Patient education and counseling》2011,83(2):158-162
Objective
Communication during medical interviews plays a large role in patient adherence, satisfaction with care, and health outcomes. Both verbal and non-verbal communication (NVC) skills are central to the development of rapport between patients and healthcare professionals. The purpose of this study was to assess the role of non-verbal and verbal communication skills on evaluations by standardized patients during an ethnogeriatric Objective Structured Clinical Examination (OSCE).Methods
Interviews from 19 medical students, residents, and fellows in an ethnogeriatric OSCE were analyzed. Each interview was videotaped and evaluated on a 14 item verbal and an 8 item non-verbal communication checklist. The relationship between verbal and non-verbal communication skills on interview evaluations by standardized patients were examined using correlational analyses.Results
Maintaining adequate facial expression (FE), using affirmative gestures (AG), and limiting both unpurposive movements (UM) and hand gestures (HG) had a significant positive effect on perception of interview quality during this OSCE. Non-verbal communication skills played a role in perception of overall interview quality as well as perception of culturally competent communication.Conclusion
Incorporating formative and summative evaluation of both verbal and non-verbal communication skills may be a critical component of curricular innovations in ethnogeriatrics, such as the OSCE. 相似文献3.
Christoph Nikendei Hans Martin BosseKatja Hoffmann Andreas MöltnerRabea Hancke Corinna ConradSoeren Huwendiek Georg F. HoffmannWolfgang Herzog Jana JüngerJobst-Hendrik Schultz 《Patient education and counseling》2011,82(1):94-99
Objective
Communication skills represent an essential component of clinical competence. In the field of pediatrics, communication between physicians and patients’ parents is characterized by particular difficulties. To investigate the effects of a parent-physician communication skills training program on OSCE performance and self-efficacy in a group control design.Methods
Parallel to their daily work in the outpatient department, intervention-group experienced clinicians in practice (n = 14) participated in a communication training with standardized parents. Control-group physicians (n = 14) did not receive any training beyond their daily work. Performance was assessed by independent video ratings of an OSCE. Both groups rated their self-efficacy prior to and following training.Results
Regarding OSCE performance, the intervention group demonstrated superior skills in building relationships with parents (p < .024) and tended to perform better in exploring parents’ problems (p < .081). The communication training program led to significant improvement in self-efficacy with respect to the specific training objectives in the intervention group (p < .046).Conclusion
Even in physicians with considerable experience, structured communication training with standardized parents leads to significant improvement in OSCE performance and self-efficacy.Practise implications
Briefness and tight structure make the presented communication training program applicable even for experienced physicians in daily clinical practice. 相似文献4.
Objective
To assess effectiveness of a training program in reducing inter-grader variability in grading communication skills during an objective structured clinical exam (OSCE).Methods
Global communication (GC) skills are assessed by standardized participants (SP) and faculty during each OSCE using a 6 item rubric. Despite criteria delineated in the GC rubric, inter-grader variability was observed. During 2008-2009 academic year, a training program was implemented before each OSCE to achieve more consistent interpretation and grading in GC skills. GC grades between SP and faculty for 2nd and 3rd level student OSCEs during 2008-2009 (post-training) were compared to 2007-2008 (pre-training). Data was analyzed using repeated measures ANOVA.Results
274 and 281 students participated in OSCEs during 2007-2008 and 2008-2009 academic years, respectively. Training significantly (P < .001) decreased grader variability between SPs and faculty. There was a greater mean difference between faculty vs. SP before training (faculty 14.68, SP 15.87) compared to after training (faculty 13.51, SP 13.78). Mean GC scores for both faculty and SPs also decreased significantly after training.Conclusion and practice implications
A training program may be necessary to reduce inter-rater variability in assessment of OSCE communication skills if it is to be truly helpful to student pharmacists learning to counsel patients. 相似文献5.
Melanie Neumann Jozien Bensing Markus WirtzAnsgar Wübker Christian Scheffer Diethard Tauschel Friedrich Edelhäuser Nicole ErnstmannHolger Pfaff 《Patient education and counseling》2011,84(2):208-216
Objective
We hypothesized that patients’ ratings of physician empathy (PE) would be higher among those with private health insurance (PHI, referring to financial incentive) than among patients with statutory health insurance (SHI).Methods
A postal survey was administered to 710 cancer patients. PE was assessed using the Consultation-and-Relational-Empathy measure. T-tests were conducted to analyse whether PHI and SHI-patients differ in their ratings of PE and variables relating to contact time with the physician. Structural-equation-modelling (SEM) verified mediating effects.Results
PHI-patients rated physician empathy higher. SEM revealed that PHI-status has a strong significant effect on frequency of talking with the physician, which has a strong significant effect (1) on PE and (2) has a moderate effect on patients’ perception of medical staff stress, thereby also affecting patients’ ratings of PE.Conclusions
Our findings suggest that PHI-status is one necessary precondition for physicians spending more time with the patient. Spending more time with the PHI-patient has two major effects: it results in a more positive perception of PE and positively impacts PHI-patients’ perception of medical staff stress, which in turn, again influences PE.Practical implications
Health policy should discuss these findings in terms of equality in receiving high-quality care. 相似文献6.
Swayden KJ Anderson KK Connelly LM Moran JS McMahon JK Arnold PM 《Patient education and counseling》2012,86(2):166-171
Objective
Patients commonly perceive that a provider has spent more time at their bedside when the provider sits rather than stands. This study provides empirical evidence for this perception.Methods
We conducted a prospective, randomized, controlled study with 120 adult post-operative inpatients admitted for elective spine surgery. The actual lengths of the interactions were compared to patients’ estimations of the time of those interactions.Results
Patients perceived the provider as present at their bedside longer when he sat, even though the actual time the physician spent at the bedside did not change significantly whether he sat or stood. Patients with whom the physician sat reported a more positive interaction and a better understanding of their condition.Conclusion
Simply sitting instead of standing at a patient's bedside can have a significant impact on patient satisfaction, patient compliance, and provider-patient rapport, all of which are known factors in decreased litigation, decreased lengths of stay, decreased costs, and improved clinical outcomes.Practice implications
Any healthcare provider may have a positive effect on doctor-patient interaction by sitting as opposed to standing during a hospital follow-up visit. 相似文献7.
Fiona Patterson Filip Lievens Máire Kerrin Neil Munro Bill Irish 《The British journal of general practice》2013,63(616):e734-e741
Background
The selection methodology for UK general practice is designed to accommodate several thousand applicants per year and targets six core attributes identified in a multi-method job-analysis studyAim
To evaluate the predictive validity of selection methods for entry into postgraduate training, comprising a clinical problem-solving test, a situational judgement test, and a selection centre.Design and setting
A three-part longitudinal predictive validity study of selection into training for UK general practice.Method
In sample 1, participants were junior doctors applying for training in general practice (n = 6824). In sample 2, participants were GP registrars 1 year into training (n = 196). In sample 3, participants were GP registrars sitting the licensing examination after 3 years, at the end of training (n = 2292). The outcome measures include: assessor ratings of performance in a selection centre comprising job simulation exercises (sample 1); supervisor ratings of trainee job performance 1 year into training (sample 2); and licensing examination results, including an applied knowledge examination and a 12-station clinical skills objective structured clinical examination (OSCE; sample 3).Results
Performance ratings at selection predicted subsequent supervisor ratings of job performance 1 year later. Selection results also significantly predicted performance on both the clinical skills OSCE and applied knowledge examination for licensing at the end of training.Conclusion
In combination, these longitudinal findings provide good evidence of the predictive validity of the selection methods, and are the first reported for entry into postgraduate training. Results show that the best predictor of work performance and training outcomes is a combination of a clinical problem-solving test, a situational judgement test, and a selection centre. Implications for selection methods for all postgraduate specialties are considered. 相似文献8.
Objective
Poor oral contraceptive (OC) knowledge may contribute to premature OC discontinuation and unintended pregnancy. Yet, to understand relationships between OC knowledge and contraceptive behavior, knowledge must be adequately measured. This review evaluates the findings and methodological limitations of research in which OC knowledge has been measured.Methods
We performed a systematic review of primary research from January 1965 to January 2009. Studies were audited for study characteristics, purpose for measuring OC knowledge, key findings and measurement properties including administration method, knowledge domains, reliability, validity, health literacy and cultural sensitivity.Results
We reviewed 21 studies: 18 cohort studies, including one psychometric evaluation, and three randomized trials. Results on OC knowledge outcomes were variable. Measures were largely self-administered survey (n = 15) and lacked assessment of all OC knowledge domains. Information on measures’ characteristics, reliability, validity, health literacy and cultural sensitivity was limited.Conclusion
Existing OC knowledge measures lack critical psychometric elements, leading to inconsistent and unreliable findings.Practice implications
Poor OC knowledge measurement precludes identifying counseling needs and developing interventions for contraceptive behavior change. Future research considerations include: measurement information in publications, psychometric evaluations, formal reliability/validity techniques, and attention to all OC knowledge domains, health literacy and cultural sensitivity. 相似文献9.
Objective
Health care professionals may assume questionnaires are burdensome to patients, and this limits their use in clinical settings and promotes simplification. However, patient adherence may improve by optimizing questionnaire attributes and contexts.Methods
This cross-sectional survey used Contingent Valuation methods to directly elicit patient preference for conventional monitoring of symptoms, versus adding a tool to monitoring. Under explicit consideration was the 10-question Edmonton Symptom Assessment System (ESAS). In the questionnaire, attributes of ESAS were sequentially altered to try and force preference reversal. A separate group of participants completed both questionnaire and interviews to explore questionnaire reliability, and extend validity.Results
Overall, 24 of 43 participants preferred using ESAS. Most important attributes to preference were frequency, specificity, and complexity. Where preference is initially against ESAS, it may reverse by simplifying the tool and its administrative processes. Interviews in 10 additional participants supported reproducibility and validity of the questionnaire method.Conclusions
Preference for using tools increases when tools are made relevant and used more appropriately.Practice implications
Questionnaires completed by patients as screening tools or aids to communication may be under-utilized. Optimization of ESAS and similar tools may be guided by empirical findings, including those obtained from Contingent Valuation methodologies. 相似文献10.
Kim S Brock DM Hess BJ Holmboe ES Gallagher TH Lipner RS Mazor KM 《Patient education and counseling》2011,84(3):359-367
Objective
Little is known about the best approaches and format for measuring physicians’ communication skills in an online environment. This study examines the reliability and validity of scores from two Web-based communication skill assessment formats.Methods
We created two online communication skill assessment formats: (a) MCQ (multiple-choice questions) consisting of video-based multiple-choice questions; (b) multi-format including video-based multiple-choice questions with rationales, Likert-type scales, and free text responses of what physicians would say to a patient. We randomized 100 general internists to each test format. Peer and patient ratings collected via the American Board of Internal Medicine (ABIM) served as validity sources.Results
Seventy-seven internists completed the tests (MCQ: 38; multi-format: 39). The adjusted reliability was 0.74 for both formats. Excellent communicators, as based on their peer and patient ratings, performed slightly better on both tests than adequate communicators, though this difference was not statistically significant. Physicians in both groups rated test format innovative (4.2 out of 5.0).Conclusion
The acceptable reliability and participants’ overall positive experiences point to the value of ongoing research into rigorous Web-based communication skills assessment.Practice implications
With efficient and reliable scoring, the Web offers an important way to measure and potentially enhance physicians’ communication skills. 相似文献11.
Hilde Eide Tom EideTone Rustøen Arnstein Finset 《Patient education and counseling》2011,82(2):156-162
Objective
A challenging but main task for clinicians is to identify patients’ concerns related to their medical conditions. The study aim was to validate a new coding scheme for identifying patients’ cues and concerns.Methods
12 videotaped consultations between nurses and pain patients were coded according to the Verona Coding Scheme for Emotional Sequences (VR-CoDES). During a metainterview each patient watched his/her own video interview with the researcher to confirm or disconfirm the identified cues and concerns. A directive or an open format was applied. Quantitative and qualitative data analyses were performed.Results
Patients’ confirmation in relation to the coding gave a sensitivity of 0.95 and specificity of 0.99 in the directive format and a sensitivity of 0.99 and specificity of 0.70 applying the open format. Through a qualitative analysis 83% of researcher-identified cues and concerns were validated. 17% were not confirmed or uncertain.Conclusion
The VR-CoDES seems to capture what are experienced as real concerns to patients, and proves to be a coding scheme with a high degree of ecological validity.Practice implications
The VR-CoDES provides a valid framework for detecting patients’ cues and concerns, and should be explored as a training tool to develop clinicians’ empathic accuracy. 相似文献12.
Objective
To understand the communication strategies international medical graduates use in medical interactions to overcome language and cultural barriers.Methods
In-depth interviews were conducted with 12 international physicians completing their residency training in internal medicine in a large hospital in Midwestern Ohio. The interview explored (a) barriers participants encountered while communicating with their patients regarding language, affect, and culture, and (b) communication convergence strategies used to make the interaction meaningful.Results
International physicians use multiple convergence strategies when interacting with their patients to account for the intercultural and intergroup differences, including repeating information, changing speaking styles, and using non-verbal communication.Practice implications
Understanding barriers to communication faced by international physicians and recognizing accommodation strategies they employ in the interaction could help in training of future international doctors who come to the U.S. to practice medicine. Early intervention could reduce the time international physicians spend navigating through the system and trying to learn by experimenting with different strategies which will allow these physicians to devote more time to patient care. We recommend developing a training manual that is instructive of the socio-cultural practices of the region where international physician will start practicing medicine. 相似文献13.
Buetow S Fuehrer A Macfarlane K McConnell D Moir F Huggard P Doerr H 《Patient education and counseling》2012,86(2):264-269
Objective
Conceptualising the doctor-patient relationship as a ‘window mirror’ exposes care delivery from doctor to self, doctor to patient, patient to self, and patient to doctor. These directions have not been measured concurrently. We aimed to develop and validate a patient questionnaire informed by this model.Methods
A modified-Delphi exercise was conducted to develop, and face and content validate, the questionnaire. Stage 2 surveyed 495 patients in general practice to assess the internal consistency and construct validity of the questionnaire.Results
The questionnaire is face and content valid. Its internal reliability and construct validity appear good. Patients who care more about their doctor also care more about themselves. A patient or doctor who cares about the other person is associated with increased self-care by that person.Conclusions
Further development and testing of the patient questionnaire is warranted to validate measurement of how patients perceive the caring they and their doctor give, and receive from, each other.Practice implications
From the patient perspective the questionnaire may increase awareness of the importance of family doctors and patients caring about each other and themselves. It may inform and evaluate medical students, educational programmes and caring in doctor-patient relationships. 相似文献14.
Han JY 《Patient education and counseling》2011,82(3):307-312
Objective
To investigate the individualized nature of eHealth communication, it is necessary for us to go beyond the conventional approach to explain the effect of eHealth initiatives. The current article proposes transaction logfile analysis as a unique method to probe the process by which individuals locate needed information and obtains benefits out of it.Methods
This article discusses the background of logfile analysis along with practical and methodological issues related to the analysis of log data.Results
This article recommends potential solutions to resolve issues discussed in the Section 2.Conclusions
This article discusses how transaction logfile analysis could benefit eHealth researchers, along with its relevance and application in health communication research. Logfile analysis could provide rich knowledge on how eHealth applications and tools work if performed on a regular basis, incorporated with appropriate measurement techniques and research design, and interpreted carefully.Practice implications
Logfile analysis can point toward important design implications for more effective eHealth applications. Further, interventions employing logfile analysis require not only well-designed research models but also interdisciplinary research team to handle the multifaceted work involved in the process. 相似文献15.
Bouet V Freret T Dutar P Billard JM Boulouard M 《Mechanisms of ageing and development》2011,132(5):240-248
Introduction
Effects of 3-month continuous environmental enrichment (EE) on cognitive abilities and on theta burst-related synaptic plasticity of CA1 hippocampal neuronal networks have been assessed in 6- and 20-month old NMRI female mice.Results
EE decreased anxiety-like behavior and improved learning and memory performances in adult but not in aged mice. Electrophysiological results in CA1 hippocampal slices showed that basal synaptic transmission was not affected by EE in adult mice whereas it was partially improved in aged animals, even though not sufficient to rescue the decrease related to aging. Besides, no effect of EE on N-methyl-d-aspartate receptor activation and theta-burst-induced long-term potentiation was found in adult or aged animals.Discussion
These results indicate that continuous EE is able to improve cognitive abilities in adult NMRI female mice, that does not correlate with changes in theta burst-related synaptic plasticity within neuronal networks. In addition, the lack of effects in aged animals suggests the existence of a critical delay for the beneficial effects of EE on cognitive aging. 相似文献16.
Objective
To investigate changes of different domains of breaking bad news (bbn) competences after a teaching module for medical students, and to collage the results generated by different approaches of evaluation.Methods
Rating of medical student-SP interactions by means of a global rating scale and a detailed checklist used by SPs and independent raters.Results
Students improved their breaking bad news competency. However, the changes vary between the different domains of bbn competency. In addition, results generated by different evaluation instruments differ.Conclusion
This study serves as a stimulus for further research on the training of specific elements of bbn and different approaches of evaluating bbn competency.Practice implications
In light of the different facets of bbn competency, it is important to set priorities regarding the teaching aims and to provide a consistent approach. 相似文献17.
Objective
Health professionals’ weight bias may impair obese patients’ interactions with providers. However, few studies have examined how negative provider attitudes affect the patient-provider relationship for obese patients. We hypothesized that higher patient body mass index (BMI) would be negatively associated with patient-provider relationship quality.Methods
We analyzed data from the 2007 Health Tracking Household Survey. BMI was the independent variable, and patient-perceived quality of the patient-provider relationship was the outcome. We performed log-binominal regression analyses accounting for complex survey design to examine the association of BMI with the patient-provider relationship.Results
Of the 15,197 adult survey respondents, the 6427 who answered the quality of care questions were eligible for analysis. Overall, 29% had a normal range BMI, 34% were overweight, and 37% were obese. We found few differences in ratings of the patient-provider relationship for overweight and obese respondents when compared to respondents with a normal range BMI.Conclusion
These unexpected findings may have occurred due to patients’ inability to perceive providers’ weight bias, measurement error in questionnaire items, or decreasing weight bias among health professionals.Practice implications
Patient's positive perceptions of providers may indicate promise for health professionals acting as motivators of behavior change in obese patients. 相似文献18.
Saha S Sanders DS Korthuis PT Cohn JA Sharp VL Haidet P Moore RD Beach MC 《Patient education and counseling》2011,85(3):e278-e284
Objective
We sought to evaluate whether cultural distance between patients and providers was associated with quality of care for people living with HIV/AIDS, and whether cultural distance helped explain racial/ethnic disparities in HIV care.Methods
We surveyed 437 patients and 45 providers at 4 HIV clinics in the U.S. We examined the association of patients’ perceived cultural distance from their providers with patient ratings of healthcare quality, trust in provider, receipt of antiretroviral therapy, medication adherence, and viral suppression. We also examined whether racial/ethnic disparities in these aspects of HIV care were mediated by cultural distance.Results
Greater cultural distance was associated with lower patient ratings of healthcare quality and less trust in providers. Compared to white patients, nonwhites had significantly lower levels of trust, adherence, and viral suppression. Adjusting for patient-provider cultural distance did not significantly affect any of these disparities (p-values for mediation >.10).Conclusion
Patient-provider cultural distance was negatively associated with perceived quality of care and trust but did not explain racial/ethnic disparities in HIV care.Practice implications
Bridging cultural differences may improve patient-provider relationships but may have limited impact in reducing racial/ethnic disparities, unless coupled with efforts to address other sources of unequal care. 相似文献19.
Blanch-Hartigan D 《Patient education and counseling》2011,82(3):370-376
Objective
To describe the development and validation of the Patient Emotion Cue Test (PECT) as a tool to measure providers’ emotion cue recognition ability.Methods
The PECT consists of 47 video clips depicting emotion cues that systematically vary in intensity of both verbal and nonverbal contents. The PECT assesses the provider's ability to detect and identify patients’ emotion cues accurately. A multi-stage development process produced the PECT. Reliability and validity were assessed in three studies.Results
Scores on the PECT are normally distributed with significantly above chance responding. Across three studies, the PECT demonstrates convergent validity through significant correlations with standardized tests representing multiple channels of emotion recognition, including the face, body, and voice. The PECT shows adequate inter-item and split-half reliability.Conclusion
The PECT is an easily administered, reliable, and valid test of emotion cue recognition.Practice implications
The PECT can be used in future research on providers’ emotion recognition ability, for evaluating self-assessment of ability, and as a teaching tool in medical schools. 相似文献20.
Lena Lindhe Söderlund Michael B. MadsonSune Rubak Per Nilsen 《Patient education and counseling》2011,84(1):16-26