Acad Psychiatry DOI 10.1007/s40596-014-0165-0
EMPIRICAL REPORT
Medical Student Communication Skills and Specialty Choice Carol I. Ping Tsao & Deborah Simpson & Robert Treat
Received: 14 February 2014 / Accepted: 7 May 2014 # Academic Psychiatry 2014
Abstract Objective The aim of this study was to determine if communication skills differ for medical students entering person or technique-oriented specialties. Methods Communication ratings by clerkship preceptors on an institutionally required end of clerkship medical student performance evaluation (SPE) form were compiled for 2011/2012 academic year (Class of 2013). M3 clerkships and the Class of 2013 match appointments were categorized as person or technique-oriented clerkships/specialties. Mean differences in SPE communication scores were determined by analyses of variance (ANOVA) and independent t tests. Score associations were determined by Pearson correlations. Inter-item reliability was reported with Cronbach alpha. Results The Class of 2013 match appointments were as follows: person-oriented (N=91) and technique-oriented (N=91) residency specialties. There was no significant difference in mean communication scores for medical students who entered person-oriented (mean 7.8, SD 0.4) versus technique-oriented (mean 7.9, SD 0.4) specialties (p=0.258) or for person-oriented clerkship (mean 7.8, SD 0.4) versus technique-oriented clerkship (mean 7.9, SD 0.6) ratings for medical students who matched into person-oriented specialties (p=0.124). Medical students who matched into technique-oriented specialties (mean 8.1, SD 0.5) received significantly higher (p= 0.001) communication ratings as compared with those
C. I. Ping Tsao (*) : R. Treat Medical College of Wisconsin, Milwaukee, WI, USA e-mail: [email protected] D. Simpson University of Wisconsin, Milwaukee, WI, USA
matching into person-oriented specialties (mean 7.8, SD 0.5) from technique-oriented clerkships. Conclusions Communication with patients and families is a complex constellation of specific abilities that appear to be influenced by the rater’s specialty. Further study is needed to determine if technique-oriented specialties communication skill rating criteria differ from those used by raters from person-oriented specialties. Keywords Medical student . Communication skills . Specialty choice Physician communication skills are integral to improving the quality, safety, and cost effectiveness of health care. [1, 2] Each of the accrediting bodies within the continuum of physician education has incorporated communication as a required competency. The Liaison Committee on Medical Education (LCME) includes specific standards emphasizing the importance of communication including ED-19 (“The curriculum of a medical education program must include specific instruction in communication skills as they relate to physician responsibilities, including communication with patients and their families, colleagues, and other health professionals.”) and ED-28 (“A medical education program must include ongoing assessment of medical students’ problem solving, clinical reasoning, decision making, and communication skills.”) [3]. The United States Medical Licensing Examination (USMLE) currently assesses examinees’ ability to gather information from patients and communicate their findings to patients and colleagues in the step 2 clinical skills examination with further enhancements to the assessment of communication skills anticipated for 2015 [4]. In addition, the Accreditation Council for Graduate Medical Education (ACGME) and the Accreditation Council for Continuing Medical Education (ACCME) have adopted communication
Acad Psychiatry
and interpersonal skills as one of its six core competencies [5]. Finally, the Association of American Medical Colleges (AAMC) along with seven other health professions outlined “Core Competencies for Interprofessional Collaborative Practice” that includes communication as one of its four competency domains [6]. The ACGME’s transition from competency to milestone assessment will be fully implemented in July 2014 for all specialties. Analysis of communication milestones required by the first seven medical specialties to enter the Next Accreditation System in July 2013, reveal possible differences in the expected emphases and/or levels of proficiency, raising the question whether some specialty physicians should be expected to possess a higher degree of skill in communication in general or at least in certain types of communication [7]. If this is to be the case, specialties that require additional expertise in communication must either recruit trainees that possess these skills prior to their entrance into the specialty, explicitly teach communication skills in postgraduate training, or both. The historical literature on specialty choice highlights a dichotomy in classifying specialties. Earlier classifications typically differentiated between “generalists” and “specialists” or “primary care” and “non-primary care” specialties. The most recent distinction is between “person-oriented” specialties and “technique-oriented” specialties [8]. Personoriented specialties are more oriented toward people [8]. Technique oriented specialties are more oriented to procedures and instruments [8]. This newest taxonomy focuses on daily physician functions rather than the care rendered or types of patients treated [8]. To ascertain if there is a relationship between communication skills and specialty choice, a Medline search was performed utilizing the following Medical Subject Headings of the National Library of Medicine: “communication/relationship skills,” “medical students,” and “medical specialty choice” in various combinations. The literature affirmed communication as a core physician competency, regardless of specialty choice, emphasizing that effective physician communication skills strengthen the bond between patients and physicians [9] and is associated with improved health outcomes [10]. Studies which explicitly examine specialty choice and medical students’ communication skills are, however, limited. One study examined performance on first year (M1) medical students’ Objective Structured Clinical Examination (OSCE) scores. Physical examination scores were significantly higher than interview scores for all medical students with the singular exception of those entering psychiatry. Students entering psychiatry had significantly higher interview scores than physical examination scores [11]. Other studies demonstrated that students with a secure relationship style are more likely to pursue primary care specialties [12], and family practice residents were more patient-centered than surgery residents [13].
To our knowledge, the specific relationship between a student’s communication skills and specialty choice has not been previously investigated. Our study aim, given the limited data available on communication skills and specialty choice, was to determine if M3 clerkship communication skills performance ratings differ for medical students entering person or technique-oriented specialties. Given their orientation toward and day-to-day interaction with people, we hypothesized medical students entering person-oriented specialties would be better communicators than medical students pursuing technique-oriented specialties.
Method Medical student performance evaluations (SPEs) posted for 182 students in each of the eight required M-3 clerkships (family medicine, internal medicine, obstetrics/gynecology, neurology, pediatrics, psychiatry, resuscitation, and perioperative medicine (RPM), and surgery) were compiled for the 2011/2012 academic year. All eight clerkships used the same SPE form which includes ten domain performance measures (communication with patients and families, history, physical examination, medical problem solving—assessment, medical problem solving—decision making, oral presentation, written documentation, patient care, technical skills, and professional behavior) rated on a nine-point scale (9 = highest). Domain measures are not further subdivided. On the “Communication with Patients and Families” domain, scores of 1 to 3 correspond to behaviors such as “talks to rather than with patients and families,” “not respectful, caring, or supportive,” “doesn’t listen, frequently interrupts, ignores non-verbal cues,” “insensitive, unaware of cultural or ethnic differences”; scores 4 to 6, “usually communicates clearly with patients and families,” “usually respectful, caring, and supportive,” “usually listens, occasionally interrupts, usually recognizes non-verbal cues,” “able to identify cultural and ethnic differences”; and scores 7 to 9, “communicates clearly and confirms patient/family understanding of information,” “respectful, caring, and supportive at all times,” “listens carefully, rarely interrupts, recognizes and responds to nonverbal cues,” “incorporates cultural and ethnic differences in planning.” A single SPE is submitted for every medical student within thirty days of the completion of a required M3 clerkship by the faculty member most responsible for the supervision of that medical student. The supervising faculty member may seek feedback from other attending colleagues and/or postgraduate trainees that worked with the medical student, but only one composite SPE is submitted.
Acad Psychiatry
The required M-3 clerkships were categorized as: (a) person-oriented clerkships (which included family medicine, internal medicine, obstetrics/gynecology, neurology, pediatrics, and psychiatry), and (b) technique-oriented clerkships (which included RPM and surgery) consistent with the literature [8]. The 2013 match appointments were also categorized according to the literature [8] as: (a) person-oriented residencies (family medicine, internal medicine, neurology, obstetrics/gynecology, pediatrics, physical medicine and rehabilitation, psychiatry), and (b) technique-oriented residencies (anesthesiology, dermatology, emergency medicine, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology, pathology, plastic surgery, radiation oncology, radiology, surgery, thoracic surgery, urology). Student match appointments were linked with scores for the “Communication with Patients and Families” domain. Mean differences in SPE scores were determined by analyses of variance (ANOVA) and independent t tests. Score associations were determined by Pearson correlations. Inter-item reliability was reported with Cronbach alpha. Data was analyzed with SPSS 15.0 (SPSS Inc., Chicago, IL). This retrospective medical student academic and residency match record review was approved, in an expedited process, by the medical school’s Institutional Review Board prior to data analysis.
Table 1 Mean communication scores split by M-3 clerkship and residency specialty using two-way analysis of variance (N=182) M-3 clerkship type
Mean (SD) Residency specialty type
Person-oriented Technique-oriented
Person-oriented (N=91)
Technique-oriented (N=91)
7.8 (0.4) 7.9 (0.6)
7.8 (0.5) 8.1 (0.5)
*p
EMPIRICAL REPORT
Medical Student Communication Skills and Specialty Choice Carol I. Ping Tsao & Deborah Simpson & Robert Treat
Received: 14 February 2014 / Accepted: 7 May 2014 # Academic Psychiatry 2014
Abstract Objective The aim of this study was to determine if communication skills differ for medical students entering person or technique-oriented specialties. Methods Communication ratings by clerkship preceptors on an institutionally required end of clerkship medical student performance evaluation (SPE) form were compiled for 2011/2012 academic year (Class of 2013). M3 clerkships and the Class of 2013 match appointments were categorized as person or technique-oriented clerkships/specialties. Mean differences in SPE communication scores were determined by analyses of variance (ANOVA) and independent t tests. Score associations were determined by Pearson correlations. Inter-item reliability was reported with Cronbach alpha. Results The Class of 2013 match appointments were as follows: person-oriented (N=91) and technique-oriented (N=91) residency specialties. There was no significant difference in mean communication scores for medical students who entered person-oriented (mean 7.8, SD 0.4) versus technique-oriented (mean 7.9, SD 0.4) specialties (p=0.258) or for person-oriented clerkship (mean 7.8, SD 0.4) versus technique-oriented clerkship (mean 7.9, SD 0.6) ratings for medical students who matched into person-oriented specialties (p=0.124). Medical students who matched into technique-oriented specialties (mean 8.1, SD 0.5) received significantly higher (p= 0.001) communication ratings as compared with those
C. I. Ping Tsao (*) : R. Treat Medical College of Wisconsin, Milwaukee, WI, USA e-mail: [email protected] D. Simpson University of Wisconsin, Milwaukee, WI, USA
matching into person-oriented specialties (mean 7.8, SD 0.5) from technique-oriented clerkships. Conclusions Communication with patients and families is a complex constellation of specific abilities that appear to be influenced by the rater’s specialty. Further study is needed to determine if technique-oriented specialties communication skill rating criteria differ from those used by raters from person-oriented specialties. Keywords Medical student . Communication skills . Specialty choice Physician communication skills are integral to improving the quality, safety, and cost effectiveness of health care. [1, 2] Each of the accrediting bodies within the continuum of physician education has incorporated communication as a required competency. The Liaison Committee on Medical Education (LCME) includes specific standards emphasizing the importance of communication including ED-19 (“The curriculum of a medical education program must include specific instruction in communication skills as they relate to physician responsibilities, including communication with patients and their families, colleagues, and other health professionals.”) and ED-28 (“A medical education program must include ongoing assessment of medical students’ problem solving, clinical reasoning, decision making, and communication skills.”) [3]. The United States Medical Licensing Examination (USMLE) currently assesses examinees’ ability to gather information from patients and communicate their findings to patients and colleagues in the step 2 clinical skills examination with further enhancements to the assessment of communication skills anticipated for 2015 [4]. In addition, the Accreditation Council for Graduate Medical Education (ACGME) and the Accreditation Council for Continuing Medical Education (ACCME) have adopted communication
Acad Psychiatry
and interpersonal skills as one of its six core competencies [5]. Finally, the Association of American Medical Colleges (AAMC) along with seven other health professions outlined “Core Competencies for Interprofessional Collaborative Practice” that includes communication as one of its four competency domains [6]. The ACGME’s transition from competency to milestone assessment will be fully implemented in July 2014 for all specialties. Analysis of communication milestones required by the first seven medical specialties to enter the Next Accreditation System in July 2013, reveal possible differences in the expected emphases and/or levels of proficiency, raising the question whether some specialty physicians should be expected to possess a higher degree of skill in communication in general or at least in certain types of communication [7]. If this is to be the case, specialties that require additional expertise in communication must either recruit trainees that possess these skills prior to their entrance into the specialty, explicitly teach communication skills in postgraduate training, or both. The historical literature on specialty choice highlights a dichotomy in classifying specialties. Earlier classifications typically differentiated between “generalists” and “specialists” or “primary care” and “non-primary care” specialties. The most recent distinction is between “person-oriented” specialties and “technique-oriented” specialties [8]. Personoriented specialties are more oriented toward people [8]. Technique oriented specialties are more oriented to procedures and instruments [8]. This newest taxonomy focuses on daily physician functions rather than the care rendered or types of patients treated [8]. To ascertain if there is a relationship between communication skills and specialty choice, a Medline search was performed utilizing the following Medical Subject Headings of the National Library of Medicine: “communication/relationship skills,” “medical students,” and “medical specialty choice” in various combinations. The literature affirmed communication as a core physician competency, regardless of specialty choice, emphasizing that effective physician communication skills strengthen the bond between patients and physicians [9] and is associated with improved health outcomes [10]. Studies which explicitly examine specialty choice and medical students’ communication skills are, however, limited. One study examined performance on first year (M1) medical students’ Objective Structured Clinical Examination (OSCE) scores. Physical examination scores were significantly higher than interview scores for all medical students with the singular exception of those entering psychiatry. Students entering psychiatry had significantly higher interview scores than physical examination scores [11]. Other studies demonstrated that students with a secure relationship style are more likely to pursue primary care specialties [12], and family practice residents were more patient-centered than surgery residents [13].
To our knowledge, the specific relationship between a student’s communication skills and specialty choice has not been previously investigated. Our study aim, given the limited data available on communication skills and specialty choice, was to determine if M3 clerkship communication skills performance ratings differ for medical students entering person or technique-oriented specialties. Given their orientation toward and day-to-day interaction with people, we hypothesized medical students entering person-oriented specialties would be better communicators than medical students pursuing technique-oriented specialties.
Method Medical student performance evaluations (SPEs) posted for 182 students in each of the eight required M-3 clerkships (family medicine, internal medicine, obstetrics/gynecology, neurology, pediatrics, psychiatry, resuscitation, and perioperative medicine (RPM), and surgery) were compiled for the 2011/2012 academic year. All eight clerkships used the same SPE form which includes ten domain performance measures (communication with patients and families, history, physical examination, medical problem solving—assessment, medical problem solving—decision making, oral presentation, written documentation, patient care, technical skills, and professional behavior) rated on a nine-point scale (9 = highest). Domain measures are not further subdivided. On the “Communication with Patients and Families” domain, scores of 1 to 3 correspond to behaviors such as “talks to rather than with patients and families,” “not respectful, caring, or supportive,” “doesn’t listen, frequently interrupts, ignores non-verbal cues,” “insensitive, unaware of cultural or ethnic differences”; scores 4 to 6, “usually communicates clearly with patients and families,” “usually respectful, caring, and supportive,” “usually listens, occasionally interrupts, usually recognizes non-verbal cues,” “able to identify cultural and ethnic differences”; and scores 7 to 9, “communicates clearly and confirms patient/family understanding of information,” “respectful, caring, and supportive at all times,” “listens carefully, rarely interrupts, recognizes and responds to nonverbal cues,” “incorporates cultural and ethnic differences in planning.” A single SPE is submitted for every medical student within thirty days of the completion of a required M3 clerkship by the faculty member most responsible for the supervision of that medical student. The supervising faculty member may seek feedback from other attending colleagues and/or postgraduate trainees that worked with the medical student, but only one composite SPE is submitted.
Acad Psychiatry
The required M-3 clerkships were categorized as: (a) person-oriented clerkships (which included family medicine, internal medicine, obstetrics/gynecology, neurology, pediatrics, and psychiatry), and (b) technique-oriented clerkships (which included RPM and surgery) consistent with the literature [8]. The 2013 match appointments were also categorized according to the literature [8] as: (a) person-oriented residencies (family medicine, internal medicine, neurology, obstetrics/gynecology, pediatrics, physical medicine and rehabilitation, psychiatry), and (b) technique-oriented residencies (anesthesiology, dermatology, emergency medicine, neurological surgery, ophthalmology, orthopedic surgery, otolaryngology, pathology, plastic surgery, radiation oncology, radiology, surgery, thoracic surgery, urology). Student match appointments were linked with scores for the “Communication with Patients and Families” domain. Mean differences in SPE scores were determined by analyses of variance (ANOVA) and independent t tests. Score associations were determined by Pearson correlations. Inter-item reliability was reported with Cronbach alpha. Data was analyzed with SPSS 15.0 (SPSS Inc., Chicago, IL). This retrospective medical student academic and residency match record review was approved, in an expedited process, by the medical school’s Institutional Review Board prior to data analysis.
Table 1 Mean communication scores split by M-3 clerkship and residency specialty using two-way analysis of variance (N=182) M-3 clerkship type
Mean (SD) Residency specialty type
Person-oriented Technique-oriented
Person-oriented (N=91)
Technique-oriented (N=91)
7.8 (0.4) 7.9 (0.6)
7.8 (0.5) 8.1 (0.5)
*p
