Evaluation of Communication Skills Among Physicians: A Systematic Review of Existing Assessment Tools.

OBJECTIVE: The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians. METHODS: This review was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, and SCOPUS) were searched up to December 2018, generating 3902 unique articles, which were screened by two authors. A total of 57 articles met the inclusion criteria and underwent full data extraction. RESULTS: Forty-five different assessment tools were identified. Only 47% of the studies mentioned underlying theories or models for designing the tool. Fifteen communication skills were assessed across the tools, the five most prevalent were information giving (46%) or gathering (40%), eliciting patients' perspectives (44%), planning/goal setting (37%), and closing the session (32%). Most tools (93%) assessed communication skills using in-person role play exercises with standardized (61%) or real (32%) patients, but only 54% described the expertise of the raters who performed the evaluations. Overall, reporting of the psychometric properties of the assessment tools was poor-moderate (4.5 ± 1.3 out of 9). CONCLUSIONS: Despite identifying several existing physician communication assessment tools, a high degree of heterogeneity between these tools, in terms of skills assessed and study quality, was observed, and most have been poorly validated. Research is needed to rigorously develop and validate accessible, convenient, "user-friendly," and easy to administer and score communication assessment tools.

Assessing Physician's Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test.

BACKGROUND: Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. OBJECTIVE: The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC-the Motivational Communication Competency Assessment Test (MC-CAT). METHODS: Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. RESULTS: The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (α=.78). CONCLUSIONS: The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases.

Immediate physiological effects of acute electronic cigarette use in humans: A systematic review and meta-analysis.

BACKGROUND: Electronic cigarettes (e-cigs) are widely used devices that were initially created to aid in smoking cessation. However, their acute physiological effects are unclear and there have been a number of E-cig and Vaping Acute Lung Injury (EVALI) events reported. RESEARCH QUESTION: What are the immediate physiological effects (i.e. cardiovascular, respiratory or blood-based responses) of acute e-cig usage in humans? STUDY DESIGN AND METHODS: PubMed, Web of Science, Cochrane and Scopus databases were searched for English or French peer-reviewed articles published until May 20, 2021 and measuring at least one physiological parameter before and after using an e-cig. The study followed PRISMA guidelines and assessed article quality using the Downs and Black checklist. Independent extraction was conducted by two reviewers. Data were pooled using random-effect models. Sensitivity analysis and meta-regressions were performed to explore heterogeneity. MAIN OUTCOMES: Systolic and diastolic blood pressure, heart rate, augmentation index (AIx75), fraction of exhaled nitric oxide (FeNO), and spirometry were the most frequently assessed parameters and were therefore chosen for meta-analyses. RESULTS: Of 19823 articles screened, 45 articles were included for the qualitative synthesis, and 27 articles (919 patients) were included in meta-analyses. Acute use of nicotine e-cig was associated with increased heart rate(SMD = 0.71; 95%CI 0.46-0.95), systolic blood pressure (SMD = 0.38; 95%CI 0.18-0.57), diastolic blood pressure (SMD = 0.52; 95%CI 0.33-0.70), and augmentation index AIx75 (SMD = 0.580; 95%CI 0.220-0.941), along with decreased FeNO (SMD = -0.26; 95%CI -0.49 to -0.04). E-cig exposure wasn't associated with significant changes in any spirometry measure. INTERPRETATION: Acute use of nicotine e-cigs was associated with statistically significant cardiovascular and respiratory responses. These devices have a physiological impact that could be clinically relevant, especially in terms of cardiovascular morbidity. However, the direct consequences of long-term e-cig use needs to be further explored.