The primary FRCA OSCE – an accurate measure of communication skills?

Abstract

Effective communication between doctors and patients is a central requirement for good clinical practice. The doctor’s interpersonal skills contribute to patient satisfaction and compliance and can positively influence health outcomes [1]. The Royal College of Anaesthetists seeks to assess candidates’ communication skills through simulated patient interviews at the primary FRCA objective structured clinical examination (OSCE). We examined the relationship between the objective OSCE mark and the subjective opinions of the participants in the interview. Candidates at the Coventry Primary FRCA Viva/OSCE course take part in mock OSCE examinations which include communication skills stations in which professional actors play the role of patients. After each such station, both the actor and the candidate were asked to complete a proforma giving their opinions of the candidates’ communication skills during the interview. A total of 32 doctor:patient encounters were recorded. These were converted to percentages and compared with each other and with the OSCE mark. Comparisons showed that there was no correlation between the OSCE score and either the patient score or the candidate score suggesting that the OSCE score was a poor predictor of simulated patient satisfaction with the interpersonal and communication skills of the doctor. Mean OSCE marks were 87%, exceeding the mean scores given by simulated patients of 65% and by candidates of 77%. The OSCE scores were compared to the simulated patient scores using the paired t-test. This showed that OSCE marks significantly exceeded the simulated patient score (p < 0.0001). The mean scores given by candidates exceeded those given by actors for all criteria measuring communication skills and satisfaction. These results suggest that the OSCE station fails adequately to assess patient satisfaction with doctors’ communication skills. The results also demonstrate that candidates have a falsely high opinion of how effectively they are communicating with patients. In training anaesthetists we must stress the importance of communication and there may be an argument for subjective patient input in the scoring of communication skills stations.