School of Medicine, Keele University, Keele, UK.
Med Teach. 2021 Sep;43(9):1070-1078. doi: 10.1080/0142159X.2021.1915467. Epub 2021 Sep 8.
Communication skills are assessed by medically-enculturated examiners using consensus frameworks which were developed with limited patient involvement. Assessments consequently risk rewarding performance which incompletely serves patients' authentic communication needs. Whilst regulators require patient involvement in assessment, little is known about how this can be achieved. We aimed to explore patients' perceptions of students' communication skills, examiner feedback and potential roles for patients in assessment.
Using constructivist grounded theory we performed cognitive stimulated, semi-structured interviews with patients who watched videos of student performances in communication-focused OSCE stations and read corresponding examiner feedback. Data were analysed using grounded theory methods.
A disconnect occurred between participants' and examiners' views of students' communication skills. Whilst patients frequently commented on students' use of medical terminology, examiners omitted to mention this in feedback. Patients' judgements of students' performances varied widely, reflecting different preferences and beliefs. Participants viewed variability as an opportunity for students to learn from diverse lived experiences. Participants perceived a variety of roles to enhance assessment authenticity.
Integrating patients into communications skills assessments could help to highlight deficiencies in students' communication which medically-enculturated examiners may miss. Overcoming the challenges inherent to this is likely to enhance graduates' preparedness for practice.
沟通技巧由具有医学背景的考官根据共识框架进行评估，这些框架是在有限的患者参与下制定的。因此，评估有风险会奖励那些不能完全满足患者真实沟通需求的表现。尽管监管机构要求患者参与评估，但对于如何实现这一点知之甚少。我们旨在探讨患者对学生沟通技巧、考官反馈以及患者在评估中的潜在角色的看法。
使用建构主义扎根理论，我们对观看了沟通为重点的客观结构化临床考试站学生表现视频并阅读了相应考官反馈的患者进行了认知刺激、半结构化访谈。使用扎根理论方法分析数据。
患者和考官对学生沟通技巧的看法存在脱节。尽管患者经常评论学生使用医学术语，但考官在反馈中忽略了这一点。患者对学生表现的判断差异很大，反映了不同的偏好和信念。参与者认为这种可变性为学生从不同的生活经历中学习提供了机会。参与者认为有多种角色可以增强评估的真实性。
将患者纳入沟通技巧评估中，可以帮助突出医学背景的考官可能错过的学生沟通中的不足之处。克服这一挑战可能会提高毕业生对实践的准备程度。
