Linda R Tewksbury, MD 1, Colleen Gillespie, PhD 2, Chase Julianne, PhD 1 and Adina Kalet, MD, MPH 1.
1 NYU School of Medicine, New York, NY, and 2 NYU Wagner Graduate School, New York, NY.
Background: While superior communication skills have been associated with improved patient outcomes, limited data are available on the impact of student communication skills on other required competencies such as the ability to obtain an accurate and complete history. High quality clinical skills assessment provides important feedback to educators regarding student skills, including important associations that can drive curricular needs.
Objective: To demonstrate the correlation between medical student communication skills and accuracy of history as assessed by a high quality Comprehensive Clinical Skills Examination (CCSE).
Design/Methods: A 6 station CASE for all 4th year medical students was designed, through collaborative effort of all core clerkship directors at our institution, to measure communication skills(CS), accuracy and completeness of history content (HG=history gathering), and physical exam skills (PE). Standardized patients were trained to assess skills using carefully designed checklists. A previously validated CS checklist was used across all 6 cases. Case-specific checklists of HG and PE skills were based on content and quality of information gathered as determined by clerkship directors and other content experts. All checklists used a 3-point scale for each behaviorally anchored item: not done, done minimally, and well done.
Results: 125/148(85%) of 4th year medical students who participated in the exam consented to have their data analyzed anonymously. Internal consistency of checklists, as measured by Cronbach alpha, was best for CS (.91), followed by HG (.80), then PE (.60). Students mean (SD) performance, as measured by % items rated well done was: CS=62.88%(11.21%), HG=43.90%(11.22%), PE=42.40%(8.17%). Across all cases, CS was highly correlated with HG(r=.47, p<.001) but not with PE(r=.12, p=.17). The correlation between CS and HG was significantly positive within all six cases, ranging from r=.19, p=.022 for a neurology-based case to r=.58,p<.001 for a pediatrics-based case.
Conclusions: Medical student performance on a CASE suggests that excellent communication skills are associated with the gathering of an accurate and complete history, particularly in pediatrics. This supports the important need for communication skills curriculum.