Assessing communication skills in a postgraduate general practice examination

Abstract

The practice of medicine is a profession which requires considerable interpersonal contact. Possessing clinical knowledge alone is therefore insufficient for successful practice. Communication skills must be of high calibre if the physician is to succeed in identifying a patient's problems, and helping the patient towards improved health. This has been long recognised by the profession, yet the public are frequently critical of their doctor's communication abilities. Medical school provides undergraduates with a basic set of skills that must be developed over the whole of their practising lives. After graduation most practitioners undergo some formalised postgraduate training or assessment. In the field of general practice, the Royal New Zealand College of General Practitioners (RNZCGP) runs both training programmes and assessments of clinical competence leading to College Membership. The Part One examination for Membership includes the assessment of communication skills as one of its components. During the period 1987 to 1991 the Part One examination of the RNZCGP was subjected to formal evaluation and a series of interventions designed to improve its ability to assess communication skills. The examination was seen to possess high reliability and some validity in its simulated patient based communication skills assessment. Initially this assessment was carried out by medically trained examiners, but in 1990 formal assessment by both the simulated patient and an independent consumer examiner was added to the medical assessment. There appear to be significant differences in medical and non-medical examiner assessment of communication skills. The simulated patient assessment also differs from the independent consumer assessment. Consumer assessment is seen to have a high reliability in test-retest studies. Consumers rate certain component skills of communication differently from medical examiners, these differences having most significance for candidates whose performances are marginal. An approach to reconciling the different viewpoints of the various assessors is described.