Council on Medical Student Education in Pediatrics


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COMSEP 2010 Albuquerque Meeting


Jennifer G. Christner, MD, Pediatrics; Brent Stansfield, PhD, Medical Education, University of Michigan, Ann Arbor, MI; Jocelyn Schiller, MD, Pediatrics, Univerisity of Michigan, Ann Arbor, MI; Arin Madenci, B.S., Medical School; Patricia Keefer, MD, Pediatrics, University of Michigan, Ann Arbor, MI


Background:  Physicians communicate with patients using email with increasing frequency. However, communication skills and professionalism issues specific to email do not appear to be readily taught in medical school curricula at this time.  Therefore, we implemented an instructive strategy where students responded to simulated patient emails in order to both teach and then evaluate students on this unique communication skill. Objective:  To assess whether an instructive session on principles of effective email communication would improve student performance on responses to simulated emails. Methods:  We developed four hypothetical emails from a parent expressing concern, anger or confusion about their child’s recent medical care.  Each chief complaint is different, but was chosen to represent commonly encountered pediatric diagnostic or management dilemmas (e.g. not treating otitis media, vaccine refusal).  During the pediatric rotation, students respond to one of these emails.   A faculty member then leads a discussion about key components of a high quality email response.  Students are then sent a final simulated email. The students’ final responses are formally assessed via a grading rubric that includes subscores for medical knowledge, communication and professionalism. This final score is incorporated as a component of their final clerkship grade. Results: Performance improved from the first to third cases (p<.0001) for total scores and all subscores. Performance improvement is sustained as students progress further in their clinical year suggesting that email communication techniques are a unique skill taught in our clerkship. Intra-class correlations of all ratings of each essay were used to estimate inter-rater reliability of total score (.85), knowledge subscore (0.89), professionalism subscore (.79), and communication subscore (.66).  Discussion:  Communicating with patients via email in an effective manner is not intuitive.  It is feasible to introduce simulated email cases/communication in a clinical clerkship as an assessment tool. The lower inter-rater reliability of the communication score suggests some disagreement among clinicians about what constitutes good communication.  We are conducting further research to investigate variation among clinicians and to gauge congruency between faculty and actual parent interpretation of email communication styles.