The teachable moment.
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Anecdotes as Topic↗
Biomedical subjects
Kathy Cole-Kelly
Publications and source records attributed to Kathy Cole-Kelly.
Assessing competence in communication and interpersonal skills: the Kalamazoo II report.
Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.
Clinical Competence↗
Satisfying the patient, but failing the test.
Communication experts convened in Kalamazoo, Michigan, in 2002 to assess current tools that evaluate physician communication skills. They noted occasional discrepancies between a patient's impression of a physician's skill and the physician's performance as measured by current checklists. The authors explore the reasons for this discrepancy and propose a research agenda to resolve it. They maintain that the patient's evaluation of physician communication skills depends upon the degree to which the patient's reason for seeking care is satisfied. Since current evaluation tools do not incorporate information to which only the patient has access, they can assess neither the meaning of the interview nor the success of the physician from the patient's point of view. The authors conclude that physicians' understanding of how well they are meeting patients' needs may require competencies that are unmeasured or only partially measured by current assessment tools, such as "flexibility" or "improvisational skills." These competencies likely reside in the nonverbal domain. The authors suggest that (1) a new tool must be developed that measures the essence, or meaning, of the visit from the patient's perspective; (2) this tool must incorporate information derived directly from the patient; and (3) research is needed to define those physician and patient behaviors that facilitate meaningful encounters.
Clinical Competence↗
Teaching communication in clinical clerkships: models from the macy initiative in health communications.
Medical educators have a responsibility to teach students to communicate effectively, yet ways to accomplish this are not well-defined. Sixty-five percent of medical schools teach communication skills, usually in the preclinical years; however, communication skills learned in the preclinical years may decline by graduation. To address these problems the New York University School of Medicine, Case Western Reserve University School of Medicine, and the University of Massachusetts Medical School collaborated to develop, establish, and evaluate a comprehensive communication skills curriculum. This work was funded by the Josiah P. Macy, Jr. Foundation and is therefore referred to as the Macy Initiative in Health Communication. The three schools use a variety of methods to teach third-year students in each school a set of effective clinical communication skills. In a controlled trial this cross-institutional curriculum project proved effective in improving communication skills of third-year students as measured by a comprehensive, multistation, objective structured clinical examination. In this paper the authors describe the development of this unique, collaborative initiative. Grounded in a three-school consensus on the core skills and critical components of a communication skills curriculum, this article illustrates how each school tailored the curriculum to its own needs. In addition, the authors discuss the lessons learned from conducting this collaborative project, which may provide guidance to others seeking to establish effective cross-disciplinary skills curricula.
Clinical Clerkship↗
The clinical importance of defining family.
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Chronic Disease↗
Family interviewing: a review of the literature in primary care.
BACKGROUND: Interviewing families is an essential skill for family physicians, but there is little research on the process or outcomes of family interviewing in primary care. METHODS: We conducted a search of MEDLINE and PsychINFO using a wide range of terms related to family interviewing. The studies obtained were grouped into one of four categories: physicians' family orientation or level of family involvement, family genograms, family members who accompany patients to routine visits, and family conferences. RESULTS: Family history and other family information are commonly collected, and family issues are often discussed in office visits. Genograms can be reliably and accurately obtained during brief visits, but they are not commonly used, and their impact is uncertain. Family members frequently accompany patients to office visits and serve various roles. The potential benefits and risks of these visits are not fully understood. Family conferences are infrequently used but are well accepted by patients and may be a cost-effective method for reducing unnecessary health care utilization. CONCLUSIONS: Physicians use a wide range of family interviewing approaches with individual patients, with family members who accompany patients to office visits, and in family conferences. More research is needed to examine the process and outcome of these different types of family interviewing.
Communication↗