Development of the Objective, Structured Communication Assessment of Residents (OSCAR) Tool for Measuring Communication Skills With Patients

摘要

What was known Interpersonal and communication skills are essential, yet there is a dearth of effective tools to teach and assess communication skills.;What is new A tool providing new interns with an objective, structured assessment of their communication skills, using senior residents as standardized patients.;Limitations Small sample size limits generalizability. The evaluation tool requires further validation.;Bottom line The use of senior residents as standardized patients allows for immediate feedback to new interns about their communication skills and provides meaningful feedback to program directors.;Editor's Note: The online version of this article contains reliability statistics, the evaluation form, and an example of the 4 stations used in this study.;Introduction Interpersonal and communication skills are essential to physician practice. Designing tools to meaningfully teach and assess communication skills is, however, difficult and effective tools are largely lacking. Residents come from a variety of cultural and educational backgrounds that shape their ability to communicate with patients and colleagues. Providing residents with an opportunity to practice their interpersonal and communication skills in a safe environment, along with immediate constructive feedback, would assist in closing this gap in their training.1 Direct observation of residents is the most reliable and valid means of skills assessment, but has limitations, including variation in the patients and circumstances residents are exposed to, and in the observers (ie, attending physicians or senior residents).2–12 Several articles describe appropriate protocols for an objective, structured clinical examination (OSCE) and for standardized patient (SP) evaluations, yet the financial and opportunity costs of those modalities appear to be major limiting factors.13–15 Although program directors agree that communication competency is important for residents to master, there has been little agreement in the literature about how those communication skills should be evaluated.16 The purpose of our study was to create a practical, useful, and expedient evaluation of communication skills for residents, across specialties; to determine whether additional skill development was necessary; and to provide timely feedback to the program directors regarding these skills. We designed a program that used SPs to provide meaningful data to program directors and immediate feedback to the residents.17;Results Eighty-three of 91 interns (91%) from 11 training programs (table 1) completed the OSCAR process. Forty-one (49%) of the interns were women, 48 (58%) were US medical school graduates, and 46 (55%) were born in the United States. Of those born in the United States, 6 (13%) attended medical school outside the United States. Thirty-six percent (30 of 83) of the interns were non-Hispanic White, 29% (24 of 83) were from the Indian subcontinent, and 35% (29 of 83) had other ethnic origins. Twenty-seven of 46 interns (59%) born in the United States were non-Hispanic White, 10 of 46 (22%) were of Indian descent, and the remainder (9 of 46; 20%) were from other racial/ethnic backgrounds. View larger version (13K) TABLE 1Intern Demographics;Discussion We show the practicality of an SP-based assessment of interns' communication skills and demonstrate that we could implement and evaluate communication skills using a practical tool for all incoming interns, regardless of specialty. We also report that this did not require an unreasonable time commitment from senior residents and faculty. The interns' mean performance on the stations ranged from an average score of 62% to 95% of the total possible points. Our study was not designed to determine a threshold level for competence, and there was variation among stations for all participants. The narcotics refill results showed a mean performance across all groups of 62% at baseline and 79% at follow-up, suggesting that despite improveme