https://doi.org/10.4081/qrmh.2019.8213
The role of standardized patient assessment forms in medical communication skills education
Submitted: 8 April 2019
Accepted: 29 July 2019
Published: 23 August 2019
Accepted: 29 July 2019
Abstract Views: 1823
PDF: 650
APPENDIX: 193
APPENDIX: 193
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Communication skills training is a routine practice in medical education designed to instruct and evaluate future physicians in matters of patient-provider interaction. Based on the United States Medical Licensing Examination Step 2 Clinical Skills (CS), medical schools across the United States hire and train standardized patients (SPs) to act as patients in and evaluators of simulated interactions with medical students (MSs). Using discourse analysis, I examine how a computerized assessment form creates a particularized version of communication skills with implications for future practice. The 39-item checklist is completed by SPs following a simulated interaction designed to prepare third-year MSs for the Step 2 CS. Specifically, I analyze how the form is structured to make recognizable specific communication skills tasks, who should complete said tasks, and what varying degrees of communication skills competency are within the realm of task completion. By analyzing the form, I consider the agency of texts in medical education, the implications of technologizing communication as an institutional skill, and the limitations of enlisting SPs to evaluate communication skills competency under the guise of a patient perspective.
Boisy A, Windover AK, Bokar D, et al. Communication skills training for physicians improves patient satisfaction. J Gen Intern Med 2016;21:755-61.
DOI: https://doi.org/10.1007/s11606-016-3597-2
Levinson W, Lesser CS, Epstein RM. Developing physician communication skills for patient-centered care. Health Aff 2010;29:1310-8.
DOI: https://doi.org/10.1377/hlthaff.2009.0450
Levinson W, Roter D, Mullooly JP, et al. Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997;277:553-9.
DOI: https://doi.org/10.1001/jama.1997.03540310051034
United States Department of Health and Human Services; 2019. Healthy People 2020. Available from: https://www.healthypeople.gov
Association of American Medical Colleges. Contemporary issues in medicine: communication in medicine. Washington DC: Association of American Medical Colleges; 1999.
Boulet JR, Smee SM, Dillon GF, Gimpel JR. The use of standardized patient assessments for certification and licensure decisions. Simul Healthc 2009;4:35-42.
DOI: https://doi.org/10.1097/SIH.0b013e318182fc6c
Barrows HS. An overview of the uses of standardized patients for teaching and evaluating clinical skills. AAMC 1993;68:443-51.
DOI: https://doi.org/10.1097/00001888-199306000-00002
Kurtz SM, Silverman J, Draper J. Teaching and learning communication skills in medicine. Abingdon: Radcliffe Medical Press; 1997.
Eagles JM, Calder SA, Nicoll KS, Walker LG. A comparison of real patients, simulated patients and videotaped interview in teaching medical students about alcohol misuse. Med Teach 2001;23:490-3.
DOI: https://doi.org/10.3109/01421590109177949
Craig RT. The rhetoric of “dialogue” in metadiscourse: Possibility/impossibility arguments and critical events. In: Weigand E, ed. Dialogue and rhetoric. Philadelphia: John Benjamins; 2008. pp 55-67.
DOI: https://doi.org/10.1075/ds.2.06cra
Cameron D. Verbal hygiene: the politics of language. New York: Routledge; 1995.
Cameron D. Good to talk? Living and working in a communication culture. London: Sage; 2010.
Castor T, Bartesaghi M. Metacommunication during disaster response: ‘reporting’ and the constitution of problems in hurricane Katrina teleconferences. Manag Commun Q 2016;30:472-502.
DOI: https://doi.org/10.1177/0893318916646454
Katriel T, Philipsen G. ‘What we need is communication’: ‘Communication’ as a cultural category in some American speech. Commun Monog 1981;48:301-17.
DOI: https://doi.org/10.1080/03637758109376064
Makoul G. Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001;76:390-3.
DOI: https://doi.org/10.1097/00001888-200104000-00021
Epstein RM, Dannefer EF, Nofziger AC, et al. Comprehensive assessment of professional competence: the Rochester experiment. Teach Learn Med 2004;16:186-96.
DOI: https://doi.org/10.1207/s15328015tlm1602_12
Stewart M. Towards a global definition of patient centered care: the patient should be the judge of patient centered care. BMJ 2001;322:444-5.
DOI: https://doi.org/10.1136/bmj.322.7284.444
Swanson DB, van der Vleuten CPM. Assessment of clinical skills with standardized patients: state of the art revisited. Teach Learn Med 2013;25:S17-25.
DOI: https://doi.org/10.1080/10401334.2013.842916
King AM, Hoppe RB. “Best practice” for patient-centered communication: a narrative review. J Grad Med Educ 2013;5:385-93.
DOI: https://doi.org/10.4300/JGME-D-13-00072.1
Vora S, Lineberry M, Dobiesz VA. Standardized patients to assess resident interpersonal communication skills and professional values milestones. West J Emerg Med 2018;19:1019-23.
DOI: https://doi.org/10.5811/westjem.2018.8.37204
Sarangi S. Healthcare interaction as an expert communicative system: An activity analysis perspective. In Streeck J, ed. New adventures in language and interaction. Amsterdam: John Benjamins Publishing Company; 2010. pp 167-197.
DOI: https://doi.org/10.1075/pbns.196.08sar
Atkins S, Roberts C, Hawthorne K, Greenhalgh T. Simulated consultations: a sociolinguistic perspective. BMC Med Educ 2016;16:16.
DOI: https://doi.org/10.1186/s12909-016-0535-2
Atkins S, Roberts C. Assessing institutional empathy in medical settings. J Appl Ling Profess Pract 2018;13:11-33.
DOI: https://doi.org/10.1558/japl.31861
Roberts C, Sarangi S. Mapping and assessing medical students’ interactional involvement styles with patients. In: Spellman-Miller K, Thompson P, eds. Unity and diversity in language use. London: Continuum; 2002. pp 99-117.
Gumperz J. Discourse strategies. Cambridge: Cambridge University Press; 1982.
DOI: https://doi.org/10.1017/CBO9780511611834
Roberts C, Wass V, Jones R, et al. A discourse analysis of ‘good’ and ‘poor’ communication in an OSCE: A proposed new framework for teaching students. Med Educ 2003;37:192-202.
DOI: https://doi.org/10.1046/j.1365-2923.2003.01443.x
Atkins S. Assessing health professionals’ communication through role-play: an interactional analysis of simulated versus actual general practice consultations. Discourse Stud 2019;21:109-34.
DOI: https://doi.org/10.1177/1461445618802659
De la Croix A, Skelton J. The reality of role-play: interruptions and amount of talk in simulated consultations. Med Educ 2009;43:695-703.
DOI: https://doi.org/10.1111/j.1365-2923.2009.03392.x
Seale C, Butler CC, Hutchby I, et al. Negotiating frame ambiguity: a study of simulated encounters in medical education. Commun Med 2007;4:177-87.
DOI: https://doi.org/10.1515/CAM.2007.021
De la Croix A, Skelton J. The simulation game: an analysis of interactions between students and simulated patients. Med Educ 2013;47:49-58.
DOI: https://doi.org/10.1111/medu.12064
Tracy K. Discourse analysis in communication. In: Scriffin D, Tannen D, Hamilton HE, eds. The handbook of discourse analysis. 2nd ed. Malden, MA, USA: Blackwell Publishers; 2015. pp 725-749.
Bartesaghi M, Castor T. Tracing our steps through communication social construction: six propositions for how to go on. In: Galanes G, Leeds-Hurwitz W, eds. Socially constructing communication. Mahwah, NJ: Hampton Press; 2009. pp 225-243.
Barad K. Posthumanist performativity: toward an understanding of how matter comes to matter. Signs: J Women Culture Society 2003;28:801-31.
DOI: https://doi.org/10.1086/345321
Iedema R. Discourse studies in the 21st century: a response to Mats Alvesson and Dan Kärreman’s “Decolonializing discourse.” Hum Relat 2011;64:1163-76.
DOI: https://doi.org/10.1177/0018726711408365
Tracy K, Mirivel JC. Discourse analysis: The practice and practical value of taping, transcribing, and analyzing. In: Frey L, Cissna K, eds. Handbook of applied communication. Mahwah, NJ: Lawrence Erlbaum Associates; 2009. pp 153-178.
Jones RH. Spoken discourse. London: Bloomsbury Academic; 2016.
Kuhn T, Ashcraft KL, Cooren F. The work of communication: relational perspectives on working and organizing in contemporary capitalism. New York: Routledge; 2017.
DOI: https://doi.org/10.4324/9781315680705
Stubbe M, Lane C, Hilder J, et al. Multiple discourse analyses of a workplace interaction. Discourse Stud 2003;5:351-88.
DOI: https://doi.org/10.1177/14614456030053004
Antaki C, Billig M, Edwards D, Potter J. Discourse analysis means doing analysis: a critique of six shortcomings. Discourse Anal Online 2003;1. Available from: https://extra.shu.ac.uk/daol/articles/v1/n1/a1/antaki2002002.html
DOI: https://doi.org/10.5565/rev/athenea.64
Cooren F. Textual agency: how texts do things in organizational settings. Organization 2004;11:373-93.
DOI: https://doi.org/10.1177/1350508404041998
Smith DE. Texts and the ontology of organizations and institutions. Stud Cult Organ Soc 2001;7:159-98.
DOI: https://doi.org/10.1080/10245280108523557
Bartesaghi M. Intertextuality. In: Tracy K, Ilie C, Sandel T, eds. The international encyclopedia of language and social interaction. New York: Wiley & Sons; 2015.
Forbes S. Measuring disability: The agency of an attention deficit/hyperactivity disorder diagnostic questionnaire. Discourse Stud 2015;17:25-40.
DOI: https://doi.org/10.1177/1461445614557759
Galasiński D. Constructions of the self in interaction with the Beck Depression Inventory. Health 2008;12:515-33.
DOI: https://doi.org/10.1177/1363459308094423
Drew P. Contested evidence in courtroom cross-examination: the case of a trial for rape. In: Drew P, Heritage J, eds. Talk at work: interaction in institutional settings. Cambridge, UK: Cambridge University Press; 1992. pp 470-520.
Antaki C, Rapley M. ‘Quality of Life’ talk: the liberal paradox of psychological testing. Discourse Soc 1996;7:293-316.
DOI: https://doi.org/10.1177/0957926596007003002
Blatt B, Plack M, Simmens S, et al. Do standardized patients have concerns about students not captured by traditional assessment forms? Teach Learn Med 2016;28:395-405.
DOI: https://doi.org/10.1080/10401334.2016.1176573
Stivers T. Modified repeats: one method for asserting primary rights from second position. Res Lang Soc Interact 2005;38:131-58.
DOI: https://doi.org/10.1207/s15327973rlsi3802_1
Gill VT, Maynard DW. Explaining Illness: patients’ proposals and physicians’ responses. In: Heritage J, Maynard DW, eds. Communication in medical care: interaction between primary care physicians and patients. London, England: Cambridge University Press; 2006.
Pomerantz A. Agreeing and disagreeing with assessments: some features of preferred/dispreferred turn shapes. In: Atkinson M, Heritage J, eds. Structures of social action: studies in conversation analysis. Cambridge: Cambridge University Press; 1984. pp 57-101.
DOI: https://doi.org/10.1017/CBO9780511665868.008
Cooren F. Action and agency in dialogue: passion, incarnation, and ventriloquism. Amsterdam, Netherlands: John Benjamins; 2010.
DOI: https://doi.org/10.1075/ds.6
Heritage J, Maynard DW, eds. Communication in medical care: interaction between primary care physicians and patients (vol. 20). London, England: Cambridge University Press; 2006.
DOI: https://doi.org/10.1017/CBO9780511607172
Bartesaghi M. How the therapist does authority: six strategies for substituting client accounts in the session. Commun Med 2009;6:15-25.
DOI: https://doi.org/10.1558/cam.v6i1.15
Pryor L. Doctors are human too. The New York Times 2017. Available from https://www.nytimes.com/2017/04/21/opinion/doctors-are-human-too.html
How to Cite
Peters, Grace. 2019. “The Role of Standardized Patient Assessment Forms in Medical Communication Skills Education”. Qualitative Research in Medicine and Healthcare 3 (2). https://doi.org/10.4081/qrmh.2019.8213.
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