Adapting the Communication and Teamwork Skills Assessment to Assess Pre-licensure Health Care Student Team Performance in Simulation- Enhanced Interprofessional Education

Problem and goal. The article discusses the results of a comparative study of the communication skills of older preschoolers with autism spectrum disorder of the second and third autism groups according to the classification of O. Nikolskaya; A quantitative and qualitative analysis of the results obtained during the   scertaining experiment is given. A survey and assessment of communication skills was carried out using the questionnaire “Assessment of communication skills in children with autism spectrum disorders,” proposed by A. Khaustov, developed on the basis of the methodology “Assessment of social and communication skills for children with autism” (Quill, Bracken, Fair, Fiore, 2002) in two groups of senior preschoolers. The first group consisted of preschoolers with autism spectrum disorders of the second autism group; the second group is represented by preschoolers of the third group of autism. The revealed features determine differences in the content of the correctional work of a speech therapist to form communication skills in these groups of children.Problem statement: preschoolers with autism spectrum disorders of different groups receive preschool education in accordance with the recommendations of the psychological, medical and pedagogical commission.Among the individual educational routes may be getting education for children with ASD according to the adapted basic general educational program for students with severe speech impairments, receive corrective help from a speech therapist to develop communication skills. The research problem is to determine the individualized content of corrective speech therapy work with preschool children with ASD of different autism groups, taking into account the identified features of communication skills.The goal of research. We presented the results of a comparative study of the communication skills of senior preschoolers with autism spectrum disorders of the second and third autism groups and the main directions of the content of the correctional speech teacher’s work.Methodology (materials and methods). The methodological basis of the study are: provisions on the special significance of social education of L. S. Vygotsky; theoretical justification of the communication system of children with disabilities and society (G. L. Zaitseva, E. P. Kuzmicheva, V. G. Petrova, A. G. Litvak, V. I. Lubovsky and others); teachings on the general laws of development of normal and abnormal children, on the potential development of a child (L. S. Vygotsky, E. I. Gracheva, R. E. Levina, E. M. Mastyukova, etc.); the  concept of periodization of mental development in ontogenesis, the psychological theory of the game (D.B. Elkonin). The study is based on the idea of childhood autism presented by domestic and foreign authors (V.V. Lebedinsky, K.S. Lebedinskaya, O.S. Nikolskaya, E.R. Baenskaya, A.V. Khaustov, R. Jordan, D.M. Ricks, M. Sigman, JA Ungerer, L. Wing et al.). Research methods were determined in accordance with the goal, hypothesis and tasks of the work. In the course of the study, both theoretical and empirical methods were used. The bibliographic method belongs to the first, the ascertaining experiment using the questionnaire “Assessment of communication skills in children with autism spectrum disorders” proposed by A. Khaustov, developed on the basis of the methodology “Assessment of social and communication skills for children with autism”, belongs to the second. The questionnaire is used to assess the formation of communication skills in children of senior preschool and primary school age with autism spectrum disorder. Parents are primarily involved in filling out the questionnaire, who fill out the questionnaire based on the results of monitoring their own child.Results. We identified the distinctive features of the communication skills of senior preschoolers in two groups of subjects. All subjects of group A showed a low level of formation of communicative skills, and all subjects of group B showed an average. The directions of the corrective work of a speech therapist teacher with preschool children with ASD of different groups are described taking into account the identified features.

TEAMWORK is recognized as an essential component of safe patient care. In obstetric practice, a multispecialty team is frequently challenged by the emergent requirement for operative delivery in a parturient who has an underlying serious medical condition or complication of pregnancy. When a crisis complicates patient care, teamwork among healthcare professionals is frequently strained, resulting in more frequent as well as more serious failures in managing critical events. A method to measure team performance is a first step in understanding the elements of successful teamwork. In this issue of Anesthesiology, Morgan et al. 1design four complicated obstetric emergencies and evaluate the teamwork skills of obstetric teams managing these simulated events.In this study, teams managed simulated emergency operative deliveries complicated by events such as preeclampsia with pulmonary edema, abruptio placentae with massive hemorrhage, amniotic fluid embolism associated with cardiac arrest, and hypoxia associated with failed airway management. In the majority of high-acuity medical environments, teams of healthcare professionals perform specialized tasks and procedures in an interdependent manner. The interrelated team tasks, even in an emergency, usually occur in a logical, sequential, predictable manner, often with little reliance on communication, because the goals are understandable to all of the team members. When complications occur, shared communication and teamwork become essential because the immediate patient management goals may not be clear to all team members.Morgan et al. 1evaluate team performances using two different scoring methods.1The results indicate that raters are consistent when evaluating overall team performance using global ratings, but an in-depth itemized questionnaire (45 questions) that included factors such as confidence, leadership, teamwork, and information sharing could not be scored reliably. This indicates that many of the detailed characteristics of effective team performance remain elusive to measure. The promising study result is that experts consistently agreed about overall team performance. These consistent overall scores indicate that expert raters do agree on successful as well as problematic team management. The number of raters required (nine raters) to achieve a reliable score would preclude using this type of scoring system as a practical method to compare or rank-order team performances.Teamwork and communication skills continue to be difficult to capture using traditional rating scales. The development of more effective methods to measure these skills will help to identify the attributes of superior teamwork as well as the root cause of team failures. Currently, team failures are the primary target of system-based patient safety interventions. These approaches that include mandated team checks may reduce some of the more egregious teamwork failures, but ultimately, research that identifies the most effective education and training strategies is needed to improve patient safety.2,3A number of preliminary studies suggest that team members (surgeon, nurse, critical care physician, and anesthesiologist) may have differing perceptions of the quality of communication in their shared work environments.4–6Studies involving interdisciplinary healthcare teams are needed to determine why these professionals differ in their view of teamwork. This study is one of the first attempts to develop a method to measure the skills of an interdisciplinary team of healthcare professionals in a high-fidelity training environment. The training curriculum used simulated events that challenge teamwork.This work by Morgan et al. 1not only represents groundbreaking research in group interactions in complex medical emergencies, but also points the way to more effective medical education. Medical schools have recognized that prospective physicians require teamwork and communication training during medical school. A recent report entitled Educating Doctors to Provide High Quality Medical Care: A Vision for Medical Education in the United States (a report of the Ad Hoc Committee of Deans, Association of American Medical Colleges) called for changes in the system of medical education to assure that physicians can "listen and communicate effectively."7The Liaison Committee on Medical Education, jointly sponsored by the American Medical Association and the Association of American Medical Colleges, has also recognized the importance of communication skills and teamwork.6Standard ED-19 notes that "there must be specific instruction in communication skills as they relate to professional responsibilities, including communication with patients, families, colleagues and other health professionals" (Liaison Committee on Medical Education).7This committee reviews the content of a medical school's curriculum in these areas as a component of the review of the educational program leading to the M.D. degree.Medical school curricula have incorporated other methods to train and assess communication skills using more structured situations, such as the Objective Structured Clinical Exam. In addition, assessment of communication skills is now a component of the United States Medical Licensing Examination Step 2® (Philadelphia, PA) Clinical Skills Exam.6It is intriguing to consider the use of simulation, as exemplified in the study by Morgan et al. ,1as another modality to teach communication skills.Teamwork is also drawing increasing attention in medical schools as a component of patient safety and quality enhancement efforts. Students have the opportunity to participate in simulated clinical experiences and receive feedback on their performance as a team member. Increasingly, the importance of an early interdisciplinary approach has been recognized, and training has been implemented to ensure the development of interprofessional communication skills. Efforts are under way at a number of academic medical centers to develop courses in patient safety. At Creighton University, the Foundation in Patient Safety Course includes objectives that include interprofessional communication and a systems approach to understanding human performance fallibility. Similar examples of this curriculum emphasis exist at many medical schools.The overall goal is to train physicians who will be well grounded in essential communication and teamwork skills. The medical student education program will provide a foundation for further skill development in residency training. The importance of this issue to our patients will mandate that interdisciplinary communication and teamwork skills will be considered prerequisite skills for professional training. Research such as the study in this issue of Anesthesiology will and must continue to identify more effective and efficient methods to assess these skills and provide feedback to facilitate improvement.1Our patients will expect no less.* Department of Anesthesiology, Washington University School of Medicine, St. Louis, Missouri. murrayd@wustl.edu. † Department of Anesthesiology and Health Policy and Ethics, School of Medicine, Creighton University, Omaha, Nebraska.

WHILE THE IDEA THAT COMMUNICATION IS AN ESSENTIAL ASpect of medicine is not new, communication skills teaching and assessment have recently become more visible in medical education. For instance, communication skills feature prominently in a new national initiative: The National Board of Medical Examiners, the Federation of State Medical Boards, and the Educational Commission for Foreign Medical Graduates are working together to implement a clinical skills examination using standardized patients, to be taken between the third and fourth years of medical school as part of the United States Medical Licensing Examination (USMLE). This examination will “require students to demonstrate they can gather information from patients, perform a physical examination, and communicate their findings to patients and colleagues.” In 1995, the 2 bodies that accredit North American programs leading to the MD degree adopted a resolution stating that “there must be specific instruction and evaluation of [communication] skills as they relate to physician responsibilities, including communication with patients, families, colleagues and other health professionals.” While past initiatives did not generate much curricular change in medical schools, this resolution is likely to have a significant effect, given its link to program accreditation. It is important to note, however, that the standard requires only the presence of instruction and evaluation; it says nothing about the specific timing, quality, or quantity of the education. There is tremendous variation among medical schools in the way, and extent to which, communication skills are taught and assessed. The most recent and comprehensive survey on communication skills education in North American medical schools was conducted by the Association of American Medical Colleges (AAMC), and published in a 1999 report. Eighty-nine of the 144 medical schools responded to questions on the AAMC survey regarding communication skills teaching. Of these, 85% reported they use a combination of discussion, observation, and practice in teaching such skills. The primary teaching methods were small-group discussions and seminars (91%), lectures and presentations (82%), student interviews with simulated patients (79%), student observation of faculty with real patients (74%), and student interviews with real patients (72%). Nearly half of the schools (45%) reported using rounds to teach communication skills. All of these forms have value, but without a model to help structure and focus attention on communication, teaching is less likely to be consistent and effective. Ninety-two schools responded to the portion of the AAMC survey on communication skills assessment. Most of these schools (92%)reported that theyassessedcommunicationskills informally, through faculty feedback to students during teaching sessions. The next most frequently cited form of assessment was formal faculty feedback and observation (78%). More objective assessment methods, such as the use of standardized patients, were less widespread (70%). Again, the reliability and effectiveness of observation and feedback, regardless of the particular method, are likely to be compromised unless they are grounded in a coherent conceptual framework. While schools use a variety of teaching and assessment methods, many of these activities lack such a structure: At the time of the AAMC survey, less than one-third (32%) of medical schools were using a structured model to organize their communication skills teaching and assessment. Of the schools using a model, most used either the SEGUE Framework for Teaching and Assessing Communication Skills or the CalgaryCambridge Observation Guide. The focus on communication skills extends into residency and clinical practice, and is now linked specifically to accreditation of residency programs and maintenance of certification for practicing physicians. In 1999, the Accreditation Council for Graduate Medical Education, which oversees US residency programs, and the American Board of Medical Specialties, the umbrella organization for specialty boards that certify physicians, stated that “interpersonal and communication skills that result in effective information exchange and teaming with patients, their families, and other health professionals” is a core area of competency. The idea of communication as bedside manner or history taking has given way to a reconceptualization of communication as a measurable clinical skill.

BackgroundTeaching and assessment of communication skills have become essential in medical education. The Objective Structured Clinical Examination (OSCE) has been found as an appropriate means to assess communication skills within medical education. Studies have demonstrated the importance of a valid assessment of medical students’ communication skills. Yet, the validity of the performance scores depends fundamentally on the quality of the rating scales used in an OSCE. Thus, this systematic review aimed at providing an overview of existing rating scales, describing their underlying definition of communication skills, determining the methodological quality of psychometric studies and the quality of psychometric properties of the identified rating scales.MethodsWe conducted a systematic review to identify psychometrically tested rating scales, which have been applied in OSCE settings to assess communication skills of medical students. Our search strategy comprised three databases (EMBASE, PsycINFO, and PubMed), reference tracking and consultation of experts. We included studies that reported psychometric properties of communication skills assessment rating scales used in OSCEs by examiners only. The methodological quality of included studies was assessed using the COnsensus based Standards for the selection of health status Measurement INstruments (COSMIN) checklist. The quality of psychometric properties was evaluated using the quality criteria of Terwee and colleagues.ResultsData of twelve studies reporting on eight rating scales on communication skills assessment in OSCEs were included. Five of eight rating scales were explicitly developed based on a specific definition of communication skills. The methodological quality of studies was mainly poor. The psychometric quality of the eight rating scales was mainly intermediate.DiscussionOur results reveal that future psychometric evaluation studies focusing on improving the methodological quality are needed in order to yield psychometrically sound results of the OSCEs assessing communication skills. This is especially important given that most OSCE rating scales are used for summative assessment, and thus have an impact on medical students’ academic success.

The assessment of undergraduates' communication skills by means of objective structured clinical examinations (OSCEs) is a demanding task for examiners. Tiredness over the course of an examining session may introduce systematic error. In addition, unsystematic error may also be present which changes over the duration of the OSCE session. To determine the strength of some sources of systematic and unsystematic error in the assessment of communication skills over the duration of an examination schedule. Undergraduate first-year medical students completing their initial summative assessment of communication skills (a four-station OSCE) comprised the study population. Students from three cohorts were included (1996-98 intake). In all 3 years the OSCE was carried out identically. All stations lasted 5 minutes with a simulated patient. Students were assessed using an examiner (content expert) and a simulated-patient evaluation tool, the Liverpool Communication Skills Assessment Scale (LCSAS) and the Global Simulated-patient Rating Scale (GSPRS), respectively. Each student was assigned a time slot ranging from 1 to 24, where 1, for example, would denote that the student entered the exam first and 24 indicates the final slot for entry into the examination. The number of students who failed this exam was noted for each of the 24 time slots. A control set of marks from a communication skills written exam was also adopted for exploring a possible link with the time slot. Analysis was conducted using graphical display, covariate analysis and logistic regression. No significant relationship was found between the schedule point that the student entered the OSCE exam and their performance. The reliability of the content expert and simulated-patient assessments was stable throughout the session. No evidence could be found that duration of examining in a communication OSCE influenced examiners and the marks they awarded. Checks of this nature are recommended for routine inspection to confirm a lack of bias.

ObjectiveThe main aim of this study was to explore the views and perceptions of dietetic educators on their ability to assess communication skills of undergraduate student dietitians in a telehealth setting. A secondary aim was to provide recommendations to educators when assessing these skills using telehealth.MethodsA descriptive qualitative study design was used. Australian and New-Zealand dietetic educators used a validated global communication rating scale to evaluate three pre-recorded telehealth encounters. Educators then answered a series of open-ended questions on their ability to assessed communication skills in the telehealth environment.AnalysisInductive analysis allowed the emergence of themes and sub-themes independent of a specific framework or theory. Peer debriefing and triangulation increased research rigor.ResultsTwenty-four educators were included in this study with the majority (87.5%) having > 10 years experience as a dietetic educator, and 41.6% (n = 10) with experience in assessing dietetics student using telehealth. Most (76%) educators reported the assessment of non-verbal communication skills were challenging in the telehealth environment. Five themes and 15 subthemes emerged relating to advice for students and educators when assessing communication skills and a checklist was developed from recommendations that students and educators can use when preparing, planning, implementing, and assessing telehealth consultations.ConclusionAssessing student communication skills via telehealth provides a useful opportunity with the growing use of the online environment, however, it also presents challenges that must be taken into consideration. While verbal communication skills are easier to assess than non-verbal, both need to be adapted for the telehealth setting.

Central venous catheter insertions may lead to preventable adverse events. Attending physicians' central venous catheter insertion skills are not assessed routinely. We aimed to compare attending physicians' simulated central venous catheterinsertion performance to published competency standards. Prospective cohort study of attending physicians' simulated internal jugular and subclavian central venous catheter insertion skills versus a historical comparison group of residents who participated in simulation training. Fifty-eight Veterans Affairs Medical Centers from February 2014 to December 2014 during a 2-day simulation-based education curriculum and two academic medical centers in Chicago. A total of 108 experienced attending physicians and 143 internal medicine and emergency medicine residents. None. Using a previously published central venous catheter insertion skills checklist, we compared Veterans Affairs Medical Centers attending physicians' simulated central venous catheter insertion performance to the same simulated performance by internal medicine and emergency medicine residents from two academic centers. Attending physician performance was compared to residents' baseline and posttest (after simulation training) performance. Minimum passing scores were set previously by an expert panel. Attending physicians performed higher on the internal jugular (median, 75.86% items correct; interquartile range, 68.97-86.21) and subclavian (median, 83.00%; interquartile range, 59.00-86.21) assessments compared to residents' internal jugular (median, 37.04% items correct; interquartile range, 22.22-68.97) and subclavian (median, 33.33%; interquartile range, 0.00-70.37; both p < 0.001) baseline assessments. Overall simulated performance was poor because only 12 of 67 attending physicians (17.9%) met or exceeded the minimum passing score for internal jugular central venous catheter insertion and only 11 of 47 (23.4%) met or exceeded the minimum passing score for subclavian central venous catheter insertion. Resident posttest performance after simulation training was significantly higher than attending physician performance (internal jugular: median, 96%; interquartile range, 93.10-100.00; subclavian: median, 100%; interquartile range, 96.00-100.00; both p < 0.001). This study demonstrates highly variable simulated central venous catheter insertion performance among a national cohort of experienced attending physicians. Hospitals, healthcare systems, and governing bodies should recognize that even experienced physicians require periodic clinical skill assessment and retraining.

Communication is a core element of dietetic practice, and although communication skills are a prominent feature of dietetic curricula, research suggests a need for more consistent approaches. The evidence on how communication skills are taught and assessed in dietetics has not been synthesised leaving uncertainty about best practice. This scoping review aimed to examine and map the research literature relating to the teaching and assessment of communication skills in dietetics. The review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology for scoping reviews. Five electronic databases, two theses databases and eight conference proceedings were systematically searched for research on how communication skills are taught and assessed in dietetics. The search had no geographical or time limits. Studies were independently screened by two authors, summarised thematically using the Kirkpatrick Model and narratively synthesised. The 45 included studies were organised thematically into three categories: (i) the inclusion of communication skills education in dietetics, suggesting that dietitians have variable experiences; (ii) approaches to teaching communication skills in dietetics, characterised predominantly by a move away from didactic approaches in favour of experiential opportunities for learning such as simulation; and (iii) assessment of communication skills in dietetics, including the use of both dietetic-specific and generic tools. The included studies demonstrate that although a variety of teaching strategies are used in the development of communication skills in dietetics, there is potential for more robust evaluation and more diverse approaches to support dietetic educators to prepare the dietetic workforce.

Background: Good communication skills are essential components of physician-training. Effective communication between the doctor and the patient leads to better compliance, better health outcomes, decreased litigation, and higher satisfaction both for doctors and patients. The acquisition of communication and interpersonal skills is recognized and documented as a core competency for physician training in many countries. In the absence of proper training, Indian medical graduates often have less than adequate communication skills and the demand for formal training in this area has often been echoed. Aim and objectives were to know the attitude and ascertain the change in attitude, assess basic communication skills, ascertain the change in basic clinical communication skills (before and after training) and to impart training regarding communication skills by using different teaching learning methods to undergraduate medical students (third year).Methods: An interventional study was conducted using convenience sampling method. Assessment of attitude, communication skills and self-competence of communication skills was done using standardized questionnaires. Data analysis was done by using appropriate statistical tests.Results: Total 60 students participated in the study. The change in the mean scores of pre-training and post-training attitude, SEGUE (set the stage, elicit information, give information, understand patient’s perspective, end the encounter) framework score and self-assessment of communication competence scores were statistically significant before and after training.Conclusions: After training undergraduate medical students by using variety of effective training methods; their attitude towards learning communication skills changed positively and their basic clinical communication skills improved significantly.

Background: Metered dose inhalers (MDI) remain the mainstay of drug delivery in patients with bronchial asthma and other respiratory diseases for the last few decades. India has an estimated 15-20 million asthmatics; rough estimates indicate a prevalence of between 10-15% in 5-11 year old children. Its advantages include better adherence and safety profile with improved efficacy. However, imperfect inhaler use technique worsens health outcome with poor disease control. Communication and demonstration skills of health care professionals are thus vital parts of asthma therapy while educating patients regarding MDI use. Use of different devices has been included in Phase II of CBME Curriculum. Hence, communication and demonstration skills need to be learnt by all Indian medical graduates. Thus, a study was planned to assess communication and demonstration skills regarding MDI use of phase II MBBS students. Aim: To evaluate and analyse the communication and demonstration skills on the use of MDI among Phase-II MBBS students of a Medical College in Kolkata. Methods: A total of 243 second year MBBS students participated in the study. They were asked to demonstrate the correct technique of use of an MDI along with suitable communication with the interviewer who posed as a patient. The assessment of their demonstration and communication skills was done on the basis of scores obtained on a pre-validated and tested checklist. For assessment of skills, a single interviewer was appointed to avoid inter-individual bias. Students were categorised according to performance into excellent (&gt;75% scores), good (60-74%), fair (50-59%) and fail (&lt;49%) which was further classified into poor (49-35%) and very poor (&lt;35%). Results: Average scores obtained by the students were 59.2 ±28.99% and 91 ±11.64% in communication and demonstration skills respectively. Students performed significantly better with demonstration compared to communication skills (p&lt;0.001; Unpaired t test). During demonstration quite a significant number of students missed stating the steps involving deep and steady breathing to the dummy patient. As per results of communication skills 32.9%, 13.9% and 13.9% students were in excellent, good and fair categories respectively. As per results of demonstration skills 95.47%, 2.8% and 1.23% students were in excellent, good and fair categories respectively. Only 1 student failed in demonstration. However, 95 students failed in communication out of which 13.58% and 25.5% scored poor was very poor respectively. Conclusion: The study concludes that phase II medical students in this college were well versed with the steps and technique of using the MDI as seen from the high scores of demonstration skills. However they seem to be lacking in adequate communication skills while explaining the technique to a patient. Hence, there is a need for more training regarding communication skills.

Teaching communication is perceived to be of importance in dental education. Several reports have been published worldwide in the educational literature describing modifications of the dental curriculum by implementing the teaching of communication skills. Surveys which evaluate the current state of training and assessment of communication skills in dental education in different countries exist already in some countries, but little information is available about German-speaking countries. In a cross-sectional study with the aim of a census, all 36 dental schools in Germany (30), Austria (3), and Switzerland (3) were surveyed. The present survey revealed that at 26 of the 34 dental schools (76%), communication skills training has been implemented. Training of communication skills mainly takes place between the 6th and the 9th semester. Ten schools were able to implement a partly longitudinal curriculum, while the other sites only offer stand-alone courses. Of the 34 dental schools, six assess communication skills in a summative way. Three of those schools also use formative assessments for their students. Another seven sites only use formative assessment. From the various formats of assessment, OSCE is mentioned most frequently. The necessity to train and assess communication skills has reached German-speaking dental schools. The present survey allows an overview of the training and assessment of communication skills in undergraduate dental education in German-speaking Europe.

Using standardized patients to assess medical students' professionalism.

Instruction and assessment of student communication skills in US and Canadian pharmacy curricula

Assessment of communication, professionalism, and surgical skills in an objective structured performance-related examination (OSPRE): a psychometric study

Validation of the ComCare index for rater-based assessment of medical communication and interpersonal skills