Assessing Interpersonal Communications Skills: The Use of Standardized Patients in Graduate Medical Education

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Recently, much attention and increased awareness has been placed on patient-centered care in medicine.1 Within the education milieu, 1 facet of patient-centeredness is examining the communication and interpersonal skills competence of resident physicians. Interpersonal communication is 1 of the most difficult competencies in which to ensure proficiency. Many instances of patient-trainee interactions occur without the direct supervision of an attending physician. Thus, these skills are less often assessed through direct attending physician observation.Often the assessment of communication and interpersonal skills relies upon residents' United States Medical Licensing Examination (USMLE) Step 2 Clinical Skills scores obtained during medical school, which leaves a gap in adequately assessing residents' competency and comfort in using communication skills early in their practice.Extensive practice of skills is necessary to learn new skills and maintain existing competencies.2 Most communication skills courses occur at the beginning of medical school3 and often culminate with the USMLE Step 2 Clinical Skills—a performance-based MD (doctor of medicine) licensure certification assessing communication skills. After this examination, attention may shift toward Step 3 and board certifications, both of which lack an observed performance component.The use of standardized patients (SPs) is 1 way to develop and assess competency in interpersonal communication and facilitate patient-centered care. Objective Structured Clinical Examinations have also been demonstrated to be an effective tool to assess content and communication skills, knowledge, patient satisfaction, and professionalism in residency programs.4 The cost of SP programs range from $50 to $500 per resident depending on the type of exercise and the feedback provided.5–8 The cost of developing a program de novo is likely cost-prohibitive to most residency programs—in which case it might be best to focus on training faculty or staff to portray a case.Integrating SP exercises into a residency program's curriculum has the potential to fulfill requirements in the areas of patient care, interpersonal and communication skills, and formative evaluation.9 Program directors are required to “provide each resident with documented semiannual evaluation of performance with feedback.”10 This evaluation may prove beneficial with additional multimedia modalities. Some programs require digital recordings of resident-patient encounters or direct faculty observation for assessment of each resident's competency in interpersonal skills.11 A digitally recorded encounter can be used as a springboard for an individual learning plan or remediation program, or to provide documentation and evidence of a mastered skill. Standardized patient scenarios can be developed to supplement actual patient scenarios by having a resident demonstrate, role-play, or practice a skill not yet demonstrated during clinic or hospital experiences, such as treating patients from various socioeconomic and cultural backgrounds or breaking bad news. Finally, SP encounters, both summative and formative, can provide a rich resource for resident assessment and program evaluation. They can be structured to use multiple evaluators (eg, faculty, peers, patients, and other professional staff) as well.