Teaching the medical interview: methods and key learning issues in a faculty development course.

OBJECTIVE: To describe the American Academy on Communication in Healthcare's (AACH) Faculty Development Course on Teaching the Medical Interview and report a single year's outcomes. DESIGN: We delivered a Faculty Development course on Teaching the Medical Interview whose theme was relationship-centered care to a national and international audience in 1999. Participants completed a retrospective pre-post assessment of their perceived confidence in performing interview, clinical, teaching, and self-awareness skills. PARTICIPANTS AND SETTING: A total of 79 participants in the 17th annual AACH national faculty development course at the University of Massachusetts Medical School in June 1999. INTERVENTION: A 5-day course utilized the principles of learner-centered learning to teach a national and international cohort of medical school faculty about teaching the medical interview. MEASUREMENTS AND MAIN RESULTS: The course fostered individualized, self-directed learning for participants, under the guidance of AACH faculty. Teaching methods included a plenary session, small groups, workshops, and project groups all designed to aid in the achievement of individual learning goals. Course outcomes of retrospective self-assessed confidence in interview, clinical, teaching, self-awareness, and control variables were measured using a 7-point Likert scale. Participants reported improved confidence in interview, clinical, teaching, and self-awareness variables. After controlling for desirability bias as measured by control variables, only teaching and self-awareness mean change scores were statistically significant (p < .001). CONCLUSIONS: The AACH Faculty Development course on Teaching the Medical Interview utilized learner-centered teaching methods important to insure learning with experienced course participants. Perceived teaching and self-awareness skills changed the most when compared to other skills.

Assessing professionalism in the context of an objective structured clinical examination: an in-depth study of the rating process.

INTRODUCTION: Professionalism is fundamental to the practice of medicine. Objective structured clinical examinations (OSCEs) have been proposed as appropriate for assessing some aspects of professionalism. This study investigated how raters assign professionalism ratings to medical students' performances in OSCE encounters. METHODS: Three standardised patients, 3 doctor preceptors, and 3 lay people viewed and rated 20 videotaped encounters between 3rd-year medical students and standardised patients. Raters recorded their thoughts while rating. Qualitative and quantitative analyses were conducted. Comments about observable behaviours were coded, and relative frequencies were computed. Correlations between counts of categorised comments and overall professionalism ratings were also computed. RESULTS: Raters varied in which behaviours they attended to, and how behaviours were evaluated. This was true within and between rater type. Raters also differed in the behaviours they consider when providing global evaluations of professionalism. CONCLUSIONS: This study highlights the complexity of the processes involved in assigning ratings to doctor-patient encounters. Greater emphasis on behavioural definitions of specific behaviours may not be a sufficient solution, as raters appear to vary in both attention to and evaluation of behaviours. Reliance on global ratings is also problematic, especially if relatively few raters are used, for similar reasons. We propose a model highlighting the multiple points where raters viewing the same encounter may diverge, resulting in different ratings of the same performance. Progress in assessment of professionalism will require further dialogue about what constitutes professional behaviour in the medical encounter, with input from multiple constituencies and multiple representatives within each constituency.

Interpreting course evaluation results: insights from thinkaloud interviews with medical students.

PURPOSE: To determine whether some of the fundamental assumptions that frequently underlie interpretation of course evaluation results are justified by investigating what medical students are thinking as they complete a typical basic science course evaluation. METHODS: A total of 24 students participated in thinkaloud cognitive interviews, voicing their thoughts while completing a typical evaluation instrument that included items on overall course design, educational materials and methods, and faculty teaching. Students' responses were organised to consider how they interpreted questions, formed judgements and selected response options. Major themes relevant to the meaningful interpretation of course evaluation data were identified. RESULTS: Medical students understood educational terms such as 'independent learning' in different ways from both one another and common usage. When formulating responses, students' judgements were sometimes based on unique or unexpected criteria, and they described editing their judgements by considering factors such as effort or caring on the part of teaching faculty. Students tended to avoid using the lower end of the rating scale, used the highest rating option selectively, but chose the second highest category indiscriminately. CONCLUSIONS: These results call into question fundamental assumptions that frequently underlie interpretation of course evaluation results, such as whether students understand the intended meanings of terms used in items; whether faculty members who receive the same rating are perceived similarly; whether ratings actually reflect teaching effectiveness, and whether 'positive' ratings reflect positive opinions. This study also demonstrates how thinkaloud interviews can be used in validity studies, providing information to supplement statistical and psychometric analyses.

Assessing third-year medical students' breast cancer screening skills.

PURPOSE: This study assesses the relationship between students' confidence and competency in breast screening practices, compares different measurement approaches to these competencies, and assesses the effect on clinical breast examination (CBE) performance of an additional training session with a standardized patient. METHOD: In the spring of 1998, 96 third-year medical students (47 men and 49 women) at the University of Massachusetts Medical School completed knowledge items on breast cancer epidemiology and on perceived confidence in their counseling and CBE skills. The students were also rated on their performances of counseling and CBE skills. RESULTS: Higher levels of confidence in mammography counseling skills and higher interview skills scores were associated with higher mammography counseling scores. Confidence levels in performing CBE, however, were not related to the actual performances of CBE. Students' knowledge of breast cancer was modestly related to their CBE scores. Finally, the students with one extra training session with a standardized patient performed significantly better on the CBE. CONCLUSIONS: It is important to directly measure students' breast cancer screening and physical examination skills because students' reported self-confidence for some skills might not accurately reflect their actual levels of performance. Additionally, while knowledge may be an important step to acquiring skills, knowledge may not be a good indicator of students' performances of risk assessment, counseling, or physical examination. Although confidence in counseling was related to counseling performance, the stability of this perception and how that translates into future cancer-control practices remain in question.

The impact of a brief interclerkship about substance abuse on medical students' skills.

PURPOSE: To examine the immediate and delayed impact of an intensive one- or two-day interclerkship on substance abuse (SA) for third-year medical students. The program is a response to the problem of inadequacy of substance abuse education in the standard curriculum. METHOD: Each year since 1997-98 all third-year students at the University of Massachusetts Medical School have participated in a one- or two-day SA interclerkship to enhance their knowledge and competence with SA assessment and brief intervention. Students' knowledge, attitudes, and confidence were assessed immediately before and after the interclerkship. In addition, during 1998-99, each student's clinical skills in SA assessment and intervention were evaluated at the completion of the student's six-week psychiatry clerkship using objective standardized clinical examinations (OSCEs) with two simulated patients, one with and one without active SA issues. Students who took the psychiatry clerkship in the first half of the year had not yet participated in the interclerkship. Students' pooled performances before and after the interclerkship were compared. RESULTS: Students' attitudes toward and knowledge about SA disorders and their confidence about SA assessment and intervention all showed significant positive changes immediately after the interclerkship. The OSCE performance data demonstrated a significant sustained improvement in clinical skills in SA assessment and intervention as measured up to six months following the interclerkship. CONCLUSION: These data suggest that brief intensive training in SA during the clinical years of medical school can have a positive and lasting impact on students' clinical performances.