Does hearing the patient perspective improve consultation skills in examinations? An exploratory randomized controlled trial in medical undergraduate education

Abstract

Purpose: Medical education increasingly includes patient perspectives, but few studies look at the impact on students’ proficiency in standard examinations. We explored students’ exam performance after viewing video of patients’ experiences.

Methods: Eighty-eight medical students were randomized to one of two e-learning modules. The experimental group saw video clips of patients describing their colposcopy, while the control group viewed a clinician describing the procedure. Students then completed a Multiple Choice Questionnaire (MCQ) and were assessed by a blinded clinical examiner in an Objective Structured Clinical Examination (OSCE) with a blinded simulated patient (SP). The SP scored students using the Doctors’ Interpersonal Skills Questionnaire (DISQ). Students rated the module’s effect on their skills and confidence. Regression analyses were used to compare the effect of the two modules on these outcomes, adjusting for gender and graduate entry.

Results: The experimental group performed better in the OSCE than the control group (odds ratio 2.7 [95%CI 1.2–6.1]; p = 0.016). They also reported significantly more confidence in key areas, including comfort with patients’ emotions (odds ratio 6.4 [95%CI 2.7–14.9]; p < 0.0005). There were no other significant differences.

Conclusion: Teaching that included recorded elements of real patient experience significantly improved students’ examination performance and confidence.

Glossary

DISQ (Doctors’ Interpersonal Skills Questionnaire): A 12-question five-point scale developed to assess medics’ communication skills (Burford et al. 2011).

ISI (Interpersonal Skills Index): An average DISQ score expressed as a percentage (Greco et al. 2002).

Acknowledgements

The authors wish to thank the medical students who participated in this study, Katy Vincent and Alecia Nickless for their advice on statistics, the SPs and clinical examiners who conducted the OSCE exams, and Natalie Colborne, James Matejtschuk, and Damion Young for help and support with the creation and management of the teaching videos.

Ethical approval

This study was reviewed and approved by the University of Oxford’s Central University Research Ethics Committee.

Disclosure statement

The authors report no declarations of interest.

Funding

This project was funded by the Nuffield Oxford Hospital Trust.

Notes on contributors

Rosamund Snow, PhD, is a service-user researcher with a particular interest in how patient voice and experience can best contribute to medical education.

Joanna Crocker, PhD, is a post-doctoral researcher currently working to evaluate and assess the impact of patient and public involvement in health research.

Katherine Talbot, MBBS MRCOG, is a specialty trainee in Obstetrics and Gynaecology.

Jane Moore, MBBS MRCOG, is a Senior Clinical Fellow and Honorary Consultant in the Nuffield Department of Obstetrics and Gynaecology at the University of Oxford. She is a course organizer for the undergraduate teaching course in Obstetrics and Gynaecology at Oxford.

Helen Salisbury, MBBS MRCGP, is a GP and Medical Director of the Health Experiences Research Group. She is responsible for teaching and coordinating the communications skills course for medical undergraduates within Oxford Medical School.

All authors revised the final draughts and approved the final manuscript for submission. All authors agreed to be accountable for all aspects of the work.