Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Assessing competence in communication and interpersonal skills: the Kalamazoo II report.

Doubts have been raised about the effectiveness of traditional types of continuing medical education. Different strategies or combinations of strategies could prove to be more effective for improving the care provided by the general practitioner. For this reason a systematic literature analysis was carried out involving 75 studies of different strategies applied in primary health care. The strategies most often studied were feedback, reminders and group education. Educational material or group education combined with feedback was the combination most frequently studied. One third of all studies could be characterized as randomized controlled trials. Individual instruction, feedback and reminders seem to be the most effective single strategies. The most effective combined strategies appeared to be all combinations with individual instruction and the combination of peer review and feedback.

Single and Combined Strategies for Implementing Changes in Primary Care: A Literature Review

Patient-physician communication assessment instruments: 1986 to 1996 in review.

This meta-analysis demonstrates that the video feedback method has a statistically significant effect on the interaction skills of professionals in a range of contact professions. The aggregate effect, calculated on the basis of 217 experimental comparisons from 33 experimental studies involving a total of 1,058 people, was 0.40 standard deviation (SE=0.07). The effects of training were greater for programs working with a standard observation form of target skills that were central to the program. Results were more positive for outcome measures that measured positive skills rather than negative ones. In addition, molar outcome measures, which were obtained by means of an assessment scale, showed larger effects than micromeasures, which were scored using event sampling. Finally, recommendations are made for video feedback design and for future research.

/pdf/video-feedback-in-education-and-training-putting-learning-in-105280qz4b.pdf

Video Feedback in Education and Training: Putting Learning in the Picture

Measuring the involvement of patients in shared decision-making: a systematic review of instruments

A rating scale was designed to measure performance in interviewing techniques in primary care. Peer review of audiovisual recordings of their consultations showed that a group of experienced general practitioners achieved significantly higher scores on the rating scale compared with a group of similarly experienced general practitioners who did not observe their recordings. The higher scores were obtained at the expense of longer consultations. The traditional five-minute appointment system in general practice needs to be reconsidered if an improved interviewing technique results in a more favourable outcome.

https://www.bmj.com/content/bmj/1/6179/1686.full.pdf

Peer review of consultations in primary care: the use of audiovisual recordings.

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Peer review of consultations in primary care: the use of audiovisual recordings.