Dong Ting, LaRochelle Jeffrey S, Durning Steven J, Saguil Aaron, Swygert Kimberly, Artino Anthony R
Department of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Department of Family Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814.
Mil Med. 2015 Apr;180(4 Suppl):24-30. doi: 10.7205/MILMED-D-14-00565.
The Essential Elements of Communication (EEC) were developed from the Kalamazoo consensus statement on physician-patient communication. The Uniformed Services University of the Health Sciences (USU) has adopted a longitudinal curriculum to use the EEC both as a learning tool during standardized patient encounters and as an evaluation tool culminating with the end of preclerkship objective-structured clinical examinations (OSCE). Medical educators have recently emphasized the importance of teaching communication skills, as evidenced by the United States Medical Licensing Examination testing both the integrated clinical encounter (ICE) and communication and interpersonal skills (CIS) within the Step 2 Clinical Skills exam (CS).
To determine the associations between students' EEC OSCE performance at the end of the preclerkship period with later communication skills assessment and evaluation outcomes in the context of a longitudinal curriculum spanning both undergraduate medical education and graduate medical education.
Retrospective data from preclerkship (overall OSCE scores and EEC OSCE scores) and clerkship outcomes (internal medicine [IM] clinical points and average clerkship National Board of Medical Examiners [NBME] scores) were collected from 167 USU medical students from the class of 2011 and compared to individual scores on the CIS and ICE components of Step 2 CS, as well as to the communication skills component of the program directors' evaluation of trainees during their postgraduate year 1 (PGY-1) residency. In addition to bivariate Pearson correlation analysis, we conducted multiple linear regression analysis to examine the predictive power of the EEC score beyond the IM clerkship clinical points and the average NBME Subject Exams score on the outcome measures.
The EEC score was a significant predictor of the CIS score and the PGY-1 communication skills score. Beyond the average NBME Subject Exams score and the IM clerkship clinical points, the EEC score explained an additional 13% of the variance in the Step 2 CIS score and an additional 6% of the variance in the PGY-1 communication skills score. In addition, the EEC score was more closely associated with the CIS score than the ICE score.
The use of a standardized approach with a communication tool like the EEC can help explain future performance in communication skills independent of other education outcomes. In the context of a longitudinal curriculum, this information may better inform medical educators on learners' communication capabilities and more accurately direct future remediation efforts.
沟通的基本要素（EEC）源自关于医患沟通的卡拉马祖共识声明。美国健康科学统一服务大学（USU）采用了一门纵向课程，将EEC既用作标准化患者问诊期间的学习工具，又用作预科客观结构化临床考试（OSCE）结束时的评估工具。医学教育工作者最近强调了教授沟通技巧的重要性，美国医师执照考试在第二步临床技能考试（CS）中对综合临床问诊（ICE）和沟通与人际技能（CIS）进行测试就证明了这一点。
在涵盖本科医学教育和研究生医学教育的纵向课程背景下，确定预科阶段结束时学生的EEC OSCE成绩与后期沟通技能评估及评估结果之间的关联。
收集了167名2011级USU医学生预科阶段（OSCE总成绩和EEC OSCE成绩）和实习阶段结果（内科[IM]临床分数和实习阶段医学考试委员会[NBME]平均分数）的回顾性数据，并与第二步CS的CIS和ICE部分的个人分数，以及项目主任在研究生第一年（PGY - 1）住院医师培训期间对学员沟通技能部分的评估进行比较。除了双变量Pearson相关性分析外，我们还进行了多元线性回归分析，以检验EEC分数在IM实习临床分数和NBME科目考试平均分数之外对结果指标的预测能力。
EEC分数是CIS分数和PGY - 1沟通技能分数的重要预测指标。除了NBME科目考试平均分数和IM实习临床分数外，EEC分数还解释了第二步CIS分数中另外13%的方差以及PGY - 1沟通技能分数中另外6%的方差。此外，EEC分数与CIS分数的相关性比与ICE分数的相关性更强。
使用像EEC这样的沟通工具的标准化方法可以帮助解释沟通技能方面未来表现，而与其他教育成果无关。在纵向课程背景下，这些信息可以更好地让医学教育工作者了解学习者的沟通能力，并更准确地指导未来的补救工作。
