Kieran M. Kennedy

Reliability and validity of OSCE checklists used to assess the communication skills of undergraduate medical students: A systematic review☆

OBJECTIVES To explore inter-rater agreement between reviewers comparing reliability and validity of checklist forms that claim to assess the communication skills of undergraduate medical students in Objective Structured Clinical Examinations (OSCEs). METHODS Papers explaining rubrics of OSCE checklist forms were identified from Pubmed, Embase, PsycINFO, and the ProQuest Education Databases up to 2013. Included were those studies that report empirical validity or reliability values for the communication skills assessment checklists used. Excluded were those papers that did not report reliability or validity. RESULTS Papers focusing on generic communication skills, history taking, physician-patient communication, interviewing, negotiating treatment, information giving, empathy and 18 other domains (ICC -0.12-1) were identified. Regarding the validity and reliability of the communication skills checklists, agreement between reviewers was 0.45. CONCLUSIONS Heterogeneity in the rubrics used in the assessment of communication skills and a lack of agreement between reviewers makes comparison of student competences within and across institutions difficult. PRACTICE IMPLICATIONS Consideration should be afforded to the adoption of a standardized measurement instrument to assess communication skills in undergraduate medical education. Future research will focus upon evaluating the potential impact of adoption of a standardized measurement instrument.

A survey of the management of urinary tract infection in children in primary care and comparison with the NICE guidelines

BackgroundThe aim of this study was to establish current practices amongst general practitioners in the West of Ireland with regard to the investigation, diagnosis and management of urinary tract infection (UTI) in children and to evaluate these practices against recently published guidelines from the National Institute for Health and Clinical Excellence (NICE).MethodsA postal survey was performed using a questionnaire that included short clinical scenarios. All general practices in a single health region were sent a questionnaire, cover letter and SAE. Systematic postal and telephone contact was made with non-responders. The data was analysed using SPSS version 15.ResultsSixty-nine general practitioners were included in the study and 50 (72%) responded to the questionnaire. All respondents agreed that it is important to consider diagnosis of UTI in all children with unexplained fever. Doctors accurately identified relevant risk factors for UTI in the majority (87%) of cases. In collecting urine samples from a one year old child, 80% of respondents recommended the use of a urine collection bag and the remaining 20% recommended collection of a clean catch sample. Respondents differed greatly in their practice with regard to detailed investigation and specialist referral after a first episode of UTI. Co-amoxiclav was the most frequently used antibiotic for the treatment of cystitis, with most doctors prescribing a five day course.ConclusionsIn general, this study reveals a high level of clinical knowledge amongst doctors treating children with UTI in primary care in the catchment area of County Mayo. However, it also demonstrates wide variation in practice with regard to detailed investigation and specialist referral. The common practice of prescribing long courses of antibiotics when treating lower urinary tract infection is at variance with NICEs recommendation of a three day course of antibiotics for cystitis in children over three months of age when there are no atypical features.

What can GPs do for adult patients disclosing recent sexual violence

Sexual violence has a life-time prevalence of 20–25% so it follows that GPs will encounter patients who have experienced sexual violence. While international best practice is for such patients to be managed at specialist Sexual Assault Referral Centres (SARCs),1–4 of which there are more than 30 in the UK alone, GPs have several important roles to play: Patients who have experienced sexual violence frequently feel loss of control over their lives. Restoring patient autonomy and a sense of self-determination should be the overriding approach to consultations. In our experience, an open mind and non-judgemental attitude, on the part of the doctor, facilitates disclosure. When providing advice, it is useful to use phrases such as ‘let me explain the choices you have’, ‘you can decide what you think is best for you’, and ‘you can stop this consultation at any time if you wish’. SARCs offer a range of services to patients, including forensic medical examination (that is, attending to patients’ immediate medical needs, …

The relationship of victim injury to the progression of sexual crimes through the criminal justice system.

A number of factors are known to influence the progression of sexual crimes through the criminal justice system. The role of victim injury in influencing decision-making at pivotal stages has been addressed by a number of separate research projects. This article consolidates existing research evidence in order to highlight the important role that victim injury plays at each step of the legal process. The importance of accurate diagnosis and recording of victim injury is highlighted. Furthermore, by describing the significant impact that the presence of victim injury can have on the legal outcome, the importance of ensuring that cases without victim injury are correctly interpreted by the police, legal professionals, judiciary and the jury is heavily emphasised.

Heterogeneity of existing research relating to sexual violence, sexual assault and rape precludes meta-analysis of injury data

In order for medical practitioners to adequately explain to the court the findings of their clinical examinations of victims of sexual violence, they must have access to research data which will place their findings in to context. Unfortunately, existing research has reported a very wide range of injury prevalence data. This papers aims to provide an explanation for this wide variation in results and, furthermore, this paper aims to establish if it is possible to carry out a meta-analysis of existing research data, pertaining to the prevalence of injury after sexual assault. It is suggested that pooling of individual study results may allow statistically robust determination of the true prevalence of injury in victims of sexual violence. It is concluded that heterogeneity in research methodology, between existing research studies, is responsible for the broad range of reported prevalence rates. Finally, this heterogeneity is seen to preclude robust meta-analysis.

The risk of sexual assault and rape during international travel: implications for the practice of travel medicine

International travel presents a risk of sexual violence. In recent years, several high profile incidents, including the gang rape of an Indian woman aboard a bus in New Delhi in 2012, have heightened the awareness of this risk. The British Foreign and Commonwealth Office currently advises female travelers to India to “exercise caution when traveling there, even if they are traveling in a group,” on the basis that British women have been the victims of sexual assaults in Goa, Delhi, Bangalore, and Rajasthan.1 The international travel advice provided by the British Foreign and Commonwealth Office also highlights recent serious sexual attacks involving female Polish, German, and Danish travelers in 2014, and the kidnapping and sexual assault of a Japanese woman in January 2015.1 In the latter incident, a 22-year-old Japanese tourist was allegedly captured in Kolkata, India, by a tour guide using the pretence of bringing the traveler to visit a Buddhist shrine.2 It is reported that she was then locked in a secluded basement and repeatedly raped for one month before she managed to escape.3 In addition to these high profile media reports, there is also increasing research evidence demonstrating that sexual violence is frequently experienced during international travel. The European Institute of Studies on Prevention conducted a cross-sectional airport survey of more than 6,000 young people (aged 16–35 years) who were returning home from holidays in Southern European tourist resorts including Greece, Cyprus, Italy, Portugal, and Spain.4 A total of 1.5% of participants reported having had sex against their will during their holidays …

The case in favour of educating medical students about sexual violence

Abstract Medical students should be educated about sexual assault and rape. There is a strong argument in favour of such an educational intervention in all medical schools. Sexual violence is a highly prevalent medical condition that has very significant personal health consequences. Sexual violence is an issue that is frequently misunderstood by the general public and by healthcare professionals. Routine inclusion of this topic on undergraduate medical curricula should improve care provided to victims of sexual violence.

Medico-legal risk, clinical negligence and the practice of travel medicine

Traditionally a small number of clinical specialties, such as obstetrics and gynaecology, have been regarded as particularly high-risk areas of medical practice in terms of medical negligence litigation. Increasing evidence is emerging to substantiate the view that clinical negligence litigation is becoming prevalent in primary and ambulatory care settings.1–3 In common with other specialist areas of clinical practice, travel medicine presents medico-legal risks. The potential for unrecognised medico-legal risk and a lack of risk management practices in travel medicine merit consideration. In order for an allegation of negligence to be proven, four principle facts must be individually established.4 In the first instance, the travel health professional must have a duty of care to the patient. Second, that professional must have failed to reach an accepted standard of practice in the course of providing that care. Third, the patient must have suffered physical, financial, psychological and/or another form of loss. Finally, the loss must have been legally caused by the failure to provide an accepted standard of care. The onus is upon the plaintiff (i.e. the patient) to prove that negligence has occurred, and unless evidence of all four aspects is accepted by the court, the allegation of negligence will not be upheld. Travel health professionals owe a duty of care to any patient who consults them. Within that duty of care, there is an obligation to provide a standard of care that must be approved by a reputable body of opinion within the specialist area of practice. In this way, variation in clinical practice and differences in opinion between practitioners are taken into account. If there is a reasonable body of opinion to support the course of action taken, then the professional will likely be considered to have provided an appropriate standard of care. Duty of care begins …

Recommendations for teaching upon sensitive topics in forensic and legal medicine in the context of medical education pedagogy

Undergraduate medical curricula typically include forensic and legal medicine topics that are of a highly sensitive nature. Examples include suicide, child abuse, domestic and sexual violence. It is likely that some students will have direct or indirect experience of these issues which are prevalent in society. Those students are vulnerable to vicarious harm from partaking in their medical education. Even students with no direct or indirect experience of these issues may be vulnerable to vicarious trauma, particularly students who are especially empathetic to cases presented. Despite these risks, instruction relating to these topics is necessary to ensure the competencies of graduating doctors to respond appropriately to cases they encounter during their professional careers. However, risk can be minimised by a well-designed and thoughtfully delivered educational programme. We provide recommendations for the successful inclusion of sensitive forensic and legal medicine topics in undergraduate medical curricula.

Delivering Education about Sexual Violence: Reflections on the Experience of Teaching a Sensitive Topic in the Social and Health Sciences.

Sexual violence is a serious and prevalent violation that is experienced by as many as one in three people worldwide. Professionals working in areas of health, social work, law, policy-development and other fields engage with survivors of sexual violence. Their knowledge of this issue is an important determinant in how they react towards survivors and the quality of care they provide. It is essential that third-level students in the health and social sciences receive education on this topic; however, in Irish third-level education, instruction about sexual violence is often absent or minimal within these curricula. In this article the authors advocate for the inclusion of education about sexual violence within undergraduate and postgraduate social and health science programmes. They draw from their experience teaching about sexual violence in Irish third-level education to highlight the challenges and barriers in providing such instruction and provide practical pedagogical approaches and examples of how risks for students and lecturers can be mitigated and barriers reduced.