Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands.
BMC Fam Pract. 2013 May 22;14:65. doi: 10.1186/1471-2296-14-65.
Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.
We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.
In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p<0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.
Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.
医学沟通表现的评估通常侧重于评估通用的、定义明确的沟通技能。然而，在日常实践中，沟通取决于（具体的）情境因素，如对患者的熟悉程度或呈现的问题。仅仅重视通用技能的存在可能无法公正地评价医生的熟练程度。我们的目的是探索如果明确考虑情境因素，对全科医生（GP）沟通表现的评估会如何变化。
我们采用混合方法设计来探索评估结果的变化。随机抽取了 40 个日常 GP 咨询，以观察先前确定的情境因素是否可以再次观察到。该样本使用一种广泛使用的评估工具（MAAS-Global）进行了两次评分，第一次是标准方式，第二次是在明确考虑情境因素后，使用特定情境的评分协议在工作场所评估沟通表现。在第一次和第二次评分之间，确定了情境因素的存在。使用配对样本 t 检验计算项目得分差异。
在 40 次咨询中的 38 次中，情境因素提示使用特定情境的评分协议。使用 MAAS-Global 7 点量表的整体平均得分从标准评分的 2.98 增加到特定情境评分的 3.66（p<0.00）；总平均得分的效应量为 0.84。在之前的研究中，将适当沟通的最低标准得分设定为 3.17。
应用该协议后，平均总分上升到之前研究中 MAAS-Global 得分代表“适当的 GP 沟通行为”的水平。我们的发现表明，在沟通评估中纳入情境因素具有重要意义，并表明情境因素应被视为 GP 沟通评估中的“信号”而不是“噪音”。明确情境因素会导致更刻意和透明的 GP 沟通表现评分。
