Communication Skills in Standardized-Patient Assessment of Final-Year Medical Students: A Psychometric Study

The purpose of this study is toinvestigate the content-specificity ofcommunication skills. It investigates thereliability and dimensionality of standardizedpatient (SP) ratings of communication skills inan Objective Structured Clinical Examination(OSCE) for final year medical students. AnOSCE consisting of seven standardized patient(SP) encounters was administered to final-yearmedical students at four medical schools thatare members of the California Consortium forthe Assessment of Clinical Competence (N =567). For each case, SPs rated students'communication skills on the same seven items. Internal consistency coefficients werecalculated and a two-facet generalizabilitystudy was performed to investigate thereliability of the scores. An exploratoryfactor analysis was conducted to examine thedimensionality of the exam.Findings indicate that communication skillsacross the seven-case examination demonstrate areliable generic component that supportsrelative decision making, but that asignificant case-by-student interaction exists. The underlying structure further supports thecase-specific nature of students' ability tocommunicate with patients. From thesefindings, it is evident that individual'scommunication skills vary systematically withspecific cases. Implications include the needto consider the range of communication skilldemands made across the OSCE to supportgeneralization of findings, the need forinstruction to provide feedback oncommunication skills in multiple contexts, andthe need for research to further examine thestudent, patient, and presenting problem assources of variation in communication skills.