Kevin Volkan

Pediatric residents' perceptions of communication competencies: Implications for teaching.

Background: Medical regulatory organizations worldwide require competency in communication skills. Pediatric communication competencies are unique, and little is known about pediatric residents’ perceptions regarding these skills. Aim: The purpose of this study was to examine pediatric residents’ attitudes about communication skills, their perceptions of the importance of learning 15 specific communication skills relevant to pediatrics, confidence in these skills, and relevant program supports. Methods: We developed a 47-item cross-sectional questionnaire to study pediatric residents’ attitudes and perceptions regarding communication competencies. 104 pediatric housestaff in a university-affiliated program in the US were asked to complete the questionnaire. Scale variables were created and evaluated for reliability. Data were analysed using descriptive and univariate statistics. Results: Response rate was 86% (89/104). Cronbachs alpha reliabilities of the Importance Scale (r = 0.92) and Confidence Scale (r = 0.90) were excellent. Ninety nine percent of the participants agreed that learning to communicate effectively with patients was a priority. All agreed it is important to demonstrate empathy and caring, and to teach medical students to communicate effectively with patients. Pediatric residents agreed that the 15 communication competencies studied were important to learn. Most reported confidence in core communication competencies (interviewing, listening, building rapport, demonstrating caring and empathy), but only half or fewer were confident in 7 more advanced communication skills (ability to discuss end-of-life issues, speaking with children about serious illness, giving bad news, dealing with the ‘difficult’ patient/parent, cultural awareness/sensitivity, understanding psychosocial aspects, and understanding patients’ perspectives). Few reported the availability of relevant program supports for learning these skills. Conclusions: Pediatric residents perceive communication competencies as important and a priority for learning, yet report a lack of confidence in advanced communication skills and insufficient program supports. Our measurement scales can add to the evaluation of residency programs, and may provide suggestions for pediatric curricular content in core and advanced communication skills.

How well do second-year students learn physical diagnosis? Observational study of an objective structured clinical examination (OSCE)

BackgroundLittle is known about using the Objective Structured Clinical Examination (OSCE) in physical diagnosis courses. The purpose of this study was to describe student performance on an OSCE in a physical diagnosis course.MethodsCross-sectional study at Harvard Medical School, 1997–1999, for 489 second-year students.ResultsAverage total OSCE score was 57% (range 39–75%). Among clinical skills, students scored highest on patient interaction (72%), followed by examination technique (65%), abnormality identification (62%), history-taking (60%), patient presentation (60%), physical examination knowledge (47%), and differential diagnosis (40%) (p < .0001). Among 16 OSCE stations, scores ranged from 70% for arthritis to 29% for calf pain (p < .0001). Teaching sites accounted for larger adjusted differences in station scores, up to 28%, than in skill scores (9%) (p < .0001).ConclusionsStudents scored higher on interpersonal and technical skills than on interpretive or integrative skills. Station scores identified specific content that needs improved teaching.

Clinical competence assessment in radiology: introduction of an objective structured clinical examination in the medical school curriculum.

RATIONALE AND OBJECTIVES Traditional oral and written examinations can be limited in predicting future clinical performance. Therefore Objective Structured Clinical Examinations (OSCEs) have been introduced in other specialties. The authors assessed their value in radiology. MATERIALS AND METHODS The study includes 122 Harvard medical students who undertook 1-month compulsory clerkships at one of three hospitals (A, B, or C) in their 3rd and 4th year and a compulsory OSCE in their 4th year. The OSCE was constructed from five cases. Each had eight or nine standardized questions designed to test, within a set time, the perception of essential findings, their interpretation, and clinical judgment (maximum possible score, 100). Clerkship grades were high honors (score of 3), honors (score of 2), satisfactory (score of 1), and fail (score of 0). Predictors of OSCE scores-clerkship grade and affiliated hospital-were modeled as linear functions. Time elapsed between clerkship and OSCE was modeled as a nonlinear function. RESULTS Although there was a positive relation between clerkship grade and OSCE grade, it accounted for an increase of only 5.7% in OSCE score per clerkship grade and did not predict performance of individual students. Students who trained in hospital B showed significantly higher OSCE grades. OSCE scores were highest when the examination was taken 8 months after the clerkship. CONCLUSION The OSCE may be useful to uncover deficits in individuals and groups beyond the ones detected with traditional clerkship evaluations and provide guidance for remediation. The improved performance after additional clinical exposure suggests that the OSCE may be well suited to test the integration of radiologic and clinical knowledge.

Developing and evaluating a residents’ curriculum

This study examines the impact of a Bright Futures-based curriculum designed to teach pediatric residents how to integrate health education principles into everyday clinical practice. A two-phase study was conducted to evaluate the curriculum using both quantitative and qualitative methods. To measure the curriculums impact on residents’ clinical performance, a pre- and post-objective structured clinical examination (OSCE) design was administered to 14 residents in two groups: a control group (n = 8) and an intervention group (n = 6). Performance scores improved in the intervention group from pre- to post-testing in three core curriculum concepts (there was no change in the control group); performance in a fourth concept improved in both groups; and for the remaining two concepts, there was no change among the intervention group but an improvement in scores among those in the control group. Residents in the intervention group reported the curriculum to be of high quality and low difficulty. This study demonstrated that the curriculum had a positive impact on a residents perceptions of his or her practice one year after participating in the intervention. The data suggest that each of the modules can be taught, the content learned and the principles applied to ones clinical practice.