Communication Skills Self-assessment by Family Medicine Clerkship Students Undergoing an Integrated Standardized Patient Exam Presenting: Carin D. McAbee, BS Coordinator, Medical Student Education Programs Department of Family Medicine SUNY Upstate Medical University With Christopher P. Morley, PhD Assistant Professor & Vice Chair for Research Andrea T. Manyon, MD Professor & Chair

Integrated Standardized Patient Examination (ISPE) Introduction In 2008, the Department of Family Medicine at SUNY Upstate Medical University implemented an Integrated Standardized Patient Examination (ISPE) To evaluate history taking, communication, and counseling skills in it’s family medicine clerkship. An ISPE differs from a standard OSCE in that: It only has one station that contains a complex patient It integrates knowledge and skills across several domains  ADDITIONALLY, the ISPE developed at Upstate had a specific BIOPSYCHOSOCIAL focus.

Introduction, Continued As part of the process, students complete a 7-question, short-answer self-appraisal immediately post encounter. We performed a content analysis of some of these answers to assess differences between those who performed well on the ISPE, and those who performed poorly.

The Case Students see a middle-aged, overweight single mother. BIO- Suspected new diagnosis of Diabetes Mellitus after recent physical; student is following up PSYCHO- Patient has probable underlying depression SOCIAL: Patient has several social challenges (low wage job, limited education, night school) The Students are tasked with performing a problem-focused history of the patient, explaining the suspected diagnosis, and answering any questions the patient has. Faculty and trained staff rate the encounter using a checklist.

Student Self-Evaluation At the end of the student’s encounter, they answer 7 questions designed to promote self-reflection: What did you do well in communication/professionalism? patient care/history? counseling/education? What would you do to improve your performance in the future in Describe your perception of how well the patient understood you

Method Qualitative Content Analysis of self-appraisal answers entered by top and bottom 15 scorers on the ISPE. Focus on final question: “Describe your perception of how well the patient understood you” This initial content analysis is a “first-look” at the data for emerging themes.

Results Students in both groups tended to be equally self-critical, with 4/15 in each group making statements coded as distinctly self-critical in some way. Poor performers sometimes appeared to have lower self-awareness, although this is harder to quantify 4/15 High scorers tended to blame the test for shortcomings, wished for more time, vs. 1/15 for low scorers Some poor performers used more authoritarian language

Results “Describe your perception of how well the patient understood you” High Scorers Low Scorers “I think she understood me very well, but that we (she and I) ran out of time! If we had 5 or even 10 more minutes together, I think I could have completed a more thorough history and answered more of the patient's questions in depth.” “I asked multiple times if she understood and acknowledged that it was a lot of information I think she would be comfortable asking further questions if she didn’t understand.” “I feel like we had some misunderstandings early on, but I feel like we came to understand each other by the end of the visit.” “Very well, I put everything in simple language.” “She seemed slightly overwhelmed and confused. I'm not sure we were completely communicating well.”

Results “Describe your perception of how well the patient understood you” High Scorers Low Scorers “She seemed to understand what I was explaining, though I did not have time at the end to test her understanding by asking her to summarize.” “I think I got across the main points of simple things she could do without overwhelming her with technical details or long term complications. Even so, I would prefer if she saw a diabetes educator.” “I think that the patient understood me well because I asked the patient whether she understood or not..and also asked the patient to repeat after me...” “It was hard to tell given the patient's affect, but she did ask questions that involved what I had explained to her previously. I think that she understood the main points and what needed to be addressed with the preceptor. I could have had her repeat back to me the plan we had discussed.”

Conclusions This exploratory study was a “first look” at the self-appraisal texts generated by the ISPE. THEMES IDENTIFIED FOR FURTHER EXPLORATION: Self-Awareness Self-Criticism Displacement of Blame Test Patient Authoritarianism Deeper analysis in larger groups of quantitatively defined outliers necessary

Questions? http://www.upstate.edu/fmed/