A model for communication skills assessment across the undergraduate curriculum

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Practice points
• Studies suggest communication skills decline during medical school.
• Regulatory and other medical organizations recognize the importance of teaching and assessing communication skills and require assessment of competence in these skills.
• The authors describe a uniform, longitudinal approach for assessing communication competencies.
• Instituting a uniform assessment framework of communication competencies provides repeated opportunities for student assessment and feedback, and consistently reinforces basic and more complex communication skills.
• Ongoing faculty development in teaching and assessing communication skills, and training for standardized patient assessors are important.

Table 1.  Competencies and sub-competencies in communication skills adapted from the Bayer–Fetzer Kalamazoo consensus framework: the HMS Communication Skills Tool

1. Builds a relationship:

• Greets and shows interest in the patient as a person

• Uses words that show care and concern throughout the interview

• Uses tone, pace, eye contact, and posture that show care and concern

• Responds explicitly to patient statements about ideas, feelings, and values

2. Opens the discussion:

• Allows patient to complete opening statement without interruption

• Asks ‘is there anything else’ to elicit full set of concerns

• Explains and/or negotiates an agenda for the visit

3. Gathers information:

• Begins with patient narrative using open-ended questions (‘tell me about …’)

• Clarifies details as necessary with more specific or ‘yes/no’ questions

• Summarizes and gives patient opportunity to correct or add information

• Transitions effectively to additional questions

4. Understands the patient's perspective:

• Asks about life events, circumstances, other people that might affect health

• Elicits patient's beliefs, concerns and expectations about illness and treatment

5. Shares information:

• Assesses patient's understanding of problem and desire for more information

• Explains using words that are easy for patient to understand

• Asks if patient has any questions

6. Reaches agreement (if new/changed plan):

• Includes patient in choices and decisions to the extent she/he desires

• Checks for mutual understanding of diagnostic and/or treatment plans

• Asks about patient's ability to follow diagnostic and/or treatment plans

• Identifies additional resources as appropriate

7. Provides closure:

• Asks if the patient has questions, concerns, or other issues

• Summarizes

• Clarifies follow-up or contact arrangements

• Acknowledges patient and closes interview

Notes: Ratings used: 1 = poor; 2 = fair; 3 = good; 4 = very good; 5 = excellent. Source: Adapted from Essential Elements: The Communication Checklist, ©Bayer-Fetzer Group on Physician–Patient Communication in Medical Education, May 2001. Used with permission.

Table 2.  Adapted ABIM Patient Satisfaction Tool

Items:

1. Greeting you warmly; calling you by the name you prefer; being friendly; never crabby or rude

2. Treating you like you’re on the same level; never ‘talking down’ to you or treating you like a child

3. Letting you tell your story; listening carefully; asking thoughtful questions; not interrupting you while you’re talking

4. Showing interest in you as a person; not acting bored or ignoring what you have to say

5. Encouraging you to ask questions; answering them clearly; never avoiding your question or lecturing you

6. Using words you can understand when explaining your problems and treatment; explaining any technical medical terms in plainlanguage

Notes: Ratings: 1 = poor; 2 = fair; 3 = good; 4 = very good; 5 = excellent; 6 = unable to evaluate. Source: Adapted from American Board of Internal Medicine. Patient and peer assessment forms. Available at: http://www.acgme.org/outcome/downloads/IandC_1.pdf

Table 3.  Uniform communication skills assessment across the medical school curriculum

	Year 1	Year 2	Year 3		Year 4
Assessment	Patient–Doctor I ClinicalAssessment	Patient–Doctor II OSCE	Patient–Doctor III ClinicalAssessment	Core Medicine ClerkshipsCommunication SkillsAssessment	Comprehensive Clinical PracticeExamination (CPX)
Description ofexamination	Two videotaped interviewswith standardized patients(SP), mid-year and endof year, with SP andfaculty feedback	Seven 20-minute OSCE stationsincluding history-taking, physicalexamination, communicationskills, differential diagnosis, withSP and faculty feedback	Videotaped oral case presenta-tion to faculty followed bygiving bad news to a standar-dized patient; SP and facultyfeedback	1. Two faculty-observed real-patient interviews followedby faculty feedback 2. Single case standardizedpatient exercise at end ofclerkship with student self-assessment and SP andfaculty feedback**	Nine station CPX: 7 stationswith SPs; history, physicalexamination, communicationskills, differential diagnosis& some management withSP and faculty feedback
HMS assessmenttool*	HMS Communication SkillsTool* completed by facultyduring clinical assessmentand all observed interviewsthroughout the course	HMS Communication Skills Toolcompleted by SP and facultyduring seven-station OSCE	HMS Communication SkillsTool completed byfaculty – with additionalcontent-specific items	HMS Communication SkillsTool completed by facultyand used as self-assessmenttool by students	HMS Communication SkillsTool completed by SP andfaculty in 7 of 9 OSCEstations
Patient SatisfactionTool	Adapted ABIM PatientSatisfaction Tool completedby SPs at year end clinicalassessment	Adapted ABIM Patient SatisfactionTool completed by SPs at sevenOSCE stations	Adapted ABIM PatientSatisfaction Toolcompleted by SPs	Adapted ABIM PatientSatisfaction Toolcompleted by SPs	Adapted ABIM PatientSatisfaction Tool completedby SPs at seven of nineOSCE stations

Notes: *Adapted from Essential Elements: The Communication Checklist, ©Bayer-Fetzer Group on Physician–Patient Communication in Medical Education, May 2001. Used with permission. **This SP exercise occurred in 2004 only.

Academic Medicine, 76: 390–393, Bayer–Fetzer Conference on Physician–Patient Communication in Medical Education (2001) Essential elements of communication in medical encounters: the Kalamazoo consensus statement

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