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ORIGINAL ARTICLE

Correlations of Communication and Interpersonal Skills between Medical Students and Residents 1,2, 1, 1 1 1 Wan Beom Park *, Sae Ra Phyo *, Eun Young Jang , Seok Hoon Kang , Sun Jung Myung , 1,3 1 1 Hee Young Shin , Yoon-Seong Lee and Jwa-Seop Shin 1

Office of Medical Education, Departments of 2Internal Medicine, and 3Pediatrics, Seoul National University College of Medicine, Seoul, Korea

Purpose: Medical students’ communication and interpersonal skills can be evaluated by standardized patients in a clinical performance examination (CPX). The purpose of this study is to investigate which communication and interpersonal skills are more closely correlated between medical students and residents. Methods: This study included 2nd-year residents in 2009 who took the eight-station CPX as 4th-year medical students in 2006. In-patients who were cared for by the residents were asked the seven items related to interpersonal and communication skills. The correlation between the scores of these seven items in the 2006 CPX and the scores in the 2009 patient survey was evaluated. Results: Twenty-six residents, 11 in medical wards and 15 in surgical wards, participated in the study. The medical students’ total scores tended to be correlated with the residents’ scores (r=0.381, p=0.055). There was significant correlation between the scores for students and residents for ‘Explaining more explicably’ (r=0.470, p=0.015), and marginally significant correlation (r=0.385, p=0.052) for ‘Listening attentively.’ There was no significant correlation for the other five items. Conclusion: ‘Explaining more explicably’ and ‘Listening attentively’, these skills were more closely correlated between medical students and residents. These basic communication skills should be included in graduate or licensing evaluations. Key Words: Physician-patient relations, Communication, Interpersonal relations, Clinical competence

Objectives Project urges faculties to teach commu-

INTRODUCTION

nication and interpersonal skills [2]. Medical students’ competence in these skills can be evaluated by

Communication and interpersonal skills are essential

standardized patients (SPs) in a clinical performance

for successful professional conversation [1]. The Associ-

examination (CPX) [3,4,5]. SPs are trained to play a

ation of American Medical Colleges’ Medical School

specific role and to rate performance using a checklist

Received: August 3, 2010 • Revised: September 13, 2010 • Accepted: October 8, 2010 Corresponding Author: Jwa-Seop Shin Office of Medical Education, Seoul National University College of Medicine, 28 Yeongeon-dong, Jongno-gu, Seoul 110-799, Korea Tel: +82.2.740.8175 Fax: +82.2.740.8072 email: [email protected] This work was partly presented in the Best Poster Presentation at the 7th Asia Pacific Medical Education Conference in Singapore, in 2010.

Korean J Med Educ 2010 Dec; 22(4): 269-274. doi: 10.3946/kjme.2010.22.4.269. pISSN: 2005-727X eISSN: 2005-7288 Ⓒ The Korean Society of Medical Education. All rights reserved. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http:// creativecommons.org/licenses/by-nc/3.0/), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

*These authors contributed equally as first authors.

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Wan Beom Park, et al : Communication Skills of Students and Residents

including items related to patient-physician interaction. Many medical schools and licensing organizations use a CPX for the evaluation of communication and inter-

2. The CPX and communication and interpersonal skills

personal skills in high-stakes evaluations [6,7,8]. In

A CPX consisting of eight cases had been developed as

South Korea, a CPX was usually performed in 4th-year

a 4th-year assessment by the Seoul ․ Kyeonggi CPX

students in either graduate school of medicine (4 years)

Consortium (Republic of Korea). Each case required 18

or medical school (4 years) following pre-medical school

minutes to administer: 1 minute to introduce the case, 12

(2 years).

minutes for the student-SP encounter, and another 5

Several studies demonstrated that the scores on

minutes after the encounter for the student to answer

communication and interpersonal skills by SPs in CPXs

case-related questions (inter-station test) [11]. During

predict the competence of doctors in real clinical

the inter-station period, SPs completed checklists,

practice [9,10]. However, to our knowledge, there is no

which included the seven items related to communi-

data about the correlations of specific items or skills

cation and interpersonal skills.

between medical students and residents. This infor-

SPs, who had been trained and rehearsed, evaluated

mation could suggest which areas of communication and

the students on the seven items using a six-point Likert

interpersonal skills should be emphasized more in

scale. The seven items were as follows: ‘Demonstrating a

graduate or licensing examinations. The aim of this study

kind and familiar manner’, ‘Listening attentively’,

is to investigate which communication and interpersonal

‘Building a therapeutic relationship’, ‘Setting up a good

skills are more closely correlated between medical

atmosphere for communication’, ‘Demonstrating res-

students and residents.

pectful behavior’, ‘Explaining more explicably’, and ‘Demonstrating professionalism’. These items were extracted from 47 items, identified by a focus group

SUBJECTS AND METHODS

interview and a literature review, by our factor analysis on the survey results from 536 Korean patients.

1. Study participants

3. Patient survey

This study includes the 2nd-year residents (in 2009) at

For each resident, three in-patients who were under

Seoul National University Hospital (Republic of Korea)

his or her care for at least three days were surveyed on

who had taken a CPX as a summative evaluation as

the same seven items (six-point Likert scale) by two

4th-year medical students in Seoul National University

trained interviewers (Phyo SR, Jang EY) in 2009. The

College of Medicine (Republic of Korea) in 2006. Those

patients who did not consent to the survey or who were

who were not charged with in-patients or who did not

too sick to respond were appropriately excluded. The

consent to the patient survey were excluded. Written

patients were informed that three points should be

consent was obtained from all participating residents,

regarded as an average score for doctors.

and the Institutional Review Board of Seoul National University Hospital approved the study protocol.

4. Statistical analysis Descriptive results of continuous variables were

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Korean J Med Educ 2010 Dec; 22(4): 269-274.


Table 1. Scores on the Items Related to Interpersonal and Communication Skills for 26 Residents Items Demonstrating a kind and familiar manner Listening attentively Building a therapeutic relationship Setting up a good atmosphere for communication Demonstrating respectful behavior Explaining more explicably Demonstrating professionalism Total

CPX in medical school Scoresa) Percentileb) 3.25 42.0 (2.88 to 3.38) (24.0 to 84.2) 3.00 50.6 (2.63 to 3.28) (20.1 to 81.3) 3.25 49.7 (2.88 to 3.38) (24.3 to 80.0) 3.25 57.5 (3.13 to 3.41) (29.7 to 79.2) 3.32 38.8 (3.00 to 3.50) (22.6 to 77.0) 3.33 44.3 (3.11 to 3.56) (21.7 to 74.1) 3.57 48.3 (3.25 to 3.86) (24.7 to 78.6) 3.31 40.5 (3.05 to 3.47) (24.6 to 76.1)

Patient rating scores a) for residents 4.33 (3.67 to 4.50) 4.00 (3.58 to 4.54) 3.00 (2.67 to 3.75) 4.00 (3.67 to 4.54) 4.42 (3.67 to 5.00) 4.33 (3.91 to 4.75) 4.67 (4.00 to 5.00) 4.19 (3.65 to 4.45)

Data denote the median values (inter-quartile range). a) b) Six-point Likert scale (minimum, 1; maximum, 6), Percentile grades among a total of 174 graduates.

expressed as median values and inter-quartile ranges

was no significant difference in scores between genders

(IQR), and the Mann-Whitney U-test was used to

or between students from medical and surgical wards

compare continuous variables. The correlations between

(p=0.193, p=0.760).

SP ratings and patient ratings were evaluated with

As 2nd-year residents, the median of the average

Pearson’s correlation analyses. SPSS version 12.0 (SPSS

scores for these seven items in the patient survey was

Inc., Chicago, USA) was used in the data analyses.

4.19 (IQR, 3.65 to 4.45) (Table 1). The median maximal difference of three patients’ scores for each resident was 2 (IQR, 1 to 2). There was no significant difference in

RESULTS

patient-rated scores according to gender or medical/ surgical wards (p=0.595, p=0.683).

Of 96 residents who took the CPX as 4th-year medical

Total scores of the medical students tended to be

students, 26 residents (27%) participated in this study.

correlated with the residents’ scores (Pearson correlation

Their median age was 29 (IQR, 28 to 29); fourteen of the

coefficient [r]=0.381, p=0.055) (Table 2). The scores for

residents (54%) were male. Eleven residents (42%)

‘Explaining more explicably’ were significantly corre-

worked in medical wards and 15 (58%) in surgical wards.

lated between medical students and residents (r=0.470,

When rated as 4th-year medical students, the median

p=0.015). ‘Listening attentively’ showed marginally sig-

of the average scores for these seven interpersonal and

nificant correlation (r=0.385, p=0.052).

communication skills in the CPX was 3.31 (IQR, 3.05 to

There was no statistically significant correlation for

3.47) and the median percentile among the total 174

the other items: ‘Demonstrating a kind and familiar

graduates was 40.5% (IQR, 24.6 to 76.1) (Table 1). There

manner’, ‘Building a therapeutic relationship’, ‘Setting

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Table 2. Correlation between Standardized Patient Ratings in Medical School and Patient-Rated Scores of Residents for Communication and Interpersonal Skills Items Demonstrating a kind and familiar manner Listening attentively Building a therapeutic relationship Setting up a good atmosphere for communication Demonstrating respectful behavior Explaining more explicably Demonstrating professionalism Total a)

ra) 0.111 0.385 0.224 0.318 0.249 0.470 0.029 0.381

p-valueb) 0.588 0.052 0.271 0.114 0.220 0.015 0.887 0.055

Pearson correlation coefficient, b)From Pearson‘s correlation analyses.

up a good atmosphere for communication’, ‘Demon-

and summative evaluations of communication skills

strating respectful behavior’, and ‘Demonstrating pro-

[7,12,13,14]. Our study supports the predictive validity of

fessionalism’.

these examinations using SP ratings. Patient questionnaires are widely used for assessing clinical skills of physicians [15,16]. Patient ratings are

DISCUSSION

particularly suited for assessment of communication and interpersonal skills, since interpersonal experience can

This is, to our knowledge, the first longitudinal study

most accurately be measured when the evaluator is

evaluating which item in communication and inter-

personally involved in the interaction [17]. In the

personal skills is closely correlated between medical

present study, the finding that the maximal differences

students and doctors in clinical practice. Despite the time

among patients’ scores for each resident were relatively

interval of about three years between 4th-year medical

small suggests the reliability of patient ratings.

students and 2nd-year residents, the study demonstrates

There are over 25 checklist items related to communi-

that there was a correlation on the two items, ‘Listening

cation and interpersonal skills described in the literature,

attentively’ and ‘Explaining more explicably’. It suggests

but currently there is no gold standard and only a few

that these basic communication skills should be empha-

have been widely used [18]. In this study, the CPX

sized more than other communication and interpersonal

checklists included only seven items based on our

skills in graduate or licensing examinations. For exam-

previous work (as described). In addition, the items

ple, the scores from these two items may have additional

needed may be different for medical students and

points in an entrance examination for medical interns

residents. Therefore, the seven items used in this study

after graduation.

may be insufficient to evaluate residents’ communication

In addition, this study demonstrates that the SP ratings

and interpersonal skills.

in medical school CPXs can predict the patient ratings of

There was no significant correlation for five of the

residents’ communication skills. Many medical schools

seven items, but several reasons may explain this. First,

and licensing organizations use the CPX for formative

being rated might influence the medical students’

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performance in the CPX, while the patient ratings were based on residents’ routine clinical practice. Second,

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