The communication skills of medical students: video analysis, OSCE scores and attachment styles

Research questions (1) Is there a relationship between examiner communication skills scores and coded video communication scores in an OSCE? (2) Do securely attached students score higher than insecurely attached students on both coded video communication scores and examiner scores in an OSCE? Background There is solid evidence linking effective patient−doctor communication to better health and well-being outcomes for the patient, and for the delivery of high quality medical care (GMC, 2003; Haidet et al, 2002; Maguire & Pitceathly, 2002; Haidet et al, 2002). Studies have also demonstrated the importance of the practitioner-patient communication for better health outcomes, compliance and greater satisfaction for the physician (Deveugele et al 2005). Attachment theory provides a model for understanding the ways that individuals can feel, react and communicate when stressed by illness and how the professional may help manage that stress (Thompson et al, 2003). Research indicates a relationship between attachment style and treatment adherence, health care utilisation, symptom reporting, patient demands on doctors, and consultation rates (Cienchowski et al, 2001; Cienchowski et al, 2002; Tan et al, 2005). Research in this area however, has primarily focussed on patients’ attachment to the physician (Cienchowski et al, 2004). Summary of work 85% (n=254) 4th year Medical students volunteered to be videoed in a single 10 minute communication skills OSCE with simulated patients. The quality of communication was rated with an International consensus coding scheme (Del Piccolo et al., 2006) that detects and quantifies patient 3 / 8 emotional cues/concerns with associated doctor’s responses. Examiner scores on the OSCE were also collected. The majority of participating students (n=236) completed a questionnaire on attachment style. Analysis We are in the process of analysing the results. A MANOVA test will analyse the relationship between coded video communication skills scores and (a) OSCE communication skills examiner scores and (b) student attachment style. Conclusion and future directions By examining the relationship between examiner marks and video analysis of an OSCE we expect to find support for the OSCE as an effective measure of communication skills. The investigation has reaffirmed the need for current methods of assessing communication skills to be examined and compared to other reliable measures and has added to limited research on medical students’ attachment style and communication skills. It has also highlighted the need to longitudinally examine students’ communication skills outside the simulated setting. This is particularly relevant as assessment of communication skills is largely based on simulated student/patient consultations at the University of Liverpool. References 1. Ciechanowski, P. S., W. J. Katon, et al. (2001). "The patient-provider relationship: Attachment theory and adherence to treatment in diabetes." American Journal of Psychiatry 158(1): 29-35. 2. Ciechanowski, P. S., E. A. Walker., Katon, W.J., & Russo, J.E. (2002). "Attachment theory: A model for health care utilization and somatization." Psychosomatic Medicine 64(4): 660-667. 3. Ciechanowski, P. S., J. E. Russo, et al. (2004). "Attachment theory in health care: The influence of relationship style on medical students' specialty choice." Medical Education 38(3): 262270. 4. Del Piccolo, L., C. Goss, et al. (2006). "The fourth meeting of the Verona 4 / 8 Network on Sequence Analysis "Consensus finding on the appropriateness of provider responses to patient cues and concerns"." Patient Education and Counselling 61(3): 473475. 5. Deveugele, M., A. Derese, et al. (2005). "Teaching communication skills to medical students, a challenge in the curriculum?" Patient Education and Counselling 58(3): 265-270. 6. General Medical Council. (2003). “Tomorrow’s Doctors”. Regents Place: London. 7. Haidet, P., Dains, JE., Paterniti, DA., Hechtel, L., Chang, T., Tseng, E., Rogers, JC. (2002) “Medical student attitudes toward the doctor-patient relationship” Medical Education 36 (6): 568-574 8. Maguire, P. and C. Pitceathly (2002). "Key communication skills and how to acquire them." BMJ 325(7366): 697-700. 9. Tan, A., C. Zimmermann, et al. (2005). "Interpersonal processes in palliative care: An attachment perspective on the patient-clinician relationship." Palliative Medicine 19(2): 143-150. 10. Thompson, D. and P. S. Ciechanowski (2003). "Attaching a new understanding to the patient-physician relationship in family practice." Journal of the American Board of Family Practice 16(3): 219-226.