Summative assessment of medical students' communication skills and professional attitudes through observation in clinical practice

Abstract

To establish medical students' professional competence for the medical profession, we designed a standardized observation procedure and the Amsterdam Attitude and Communication Scale (AACS) with nine five-point scale items, for summative assessment of their communication skills and professional attitudes. This study examines the reliability of the AACS assessment in clinical practice. In the Academic Medical Centre, Amsterdam, The Netherlands, the performance of 442 fifth year clinical students was judged six times in two settings: behaviour in clinical practice was judged independently twice by a doctor and a nurse; one videotaped patient interview was judged independently by a doctor and by a psychologist. The final mark was obtained by averaging ratings across all six assessments. Raters were 88 doctors, 29 nurses, and three psychologists. Main outcome measures: Standard errors (SEs) for absolute judgements indicate measurement precision. Precision of AACS scores is considered sufficient with SEs smaller than 0.25. Multi-disciplinary assessment of students' clinical performance using the AACS is feasible and sufficiently precise (with an overall mean of 3.97 and standard deviation of 0.55, the absolute SE is 0.21). Judgements of behaviour in the clinic were more precise (SEs range from 0.11 to 0.16) than judgements of videotaped interviews (SEs are 0.25 and 0.29). The procedure is sufficiently precise if five or six assessments are combined.

Notes

Notes on contributors

HANNEKE DE HAES, PhD, is Professor and Head of the Department of Medical Psychology at the Academic Medical Centre, University of Amsterdam. As a supervisor of this study, she was involved in the study concept and design, interpretation of data, drafting and critical revision of the manuscript.

FRANS OORT, PhD, is Statistical Methodologist at the Department of Medical Psychology at the Academic Medical Centre, University of Amsterdam. He was involved in the study concept and design, statistical analysis and interpretation of data, drafting and critical revision of the manuscript.

ROBERT HULSMAN, PhD, is a teacher and researcher on medical communication skills. His principal area of interest is assessment of communication skills. He was involved in drafting and critical revision of the manuscript.