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Biomedical subjects

Val Wass

Publications and source records attributed to Val Wass.

12 recordsLinked to original sources
PubMed2005

Misunderstandings: a qualitative study of primary care consultations in multilingual settings, and educational implications.

BACKGROUND: Patients in inner-city areas come from increasingly diverse language and cultural backgrounds. Neither communications training modelled on local English speakers nor the provision of interpreters offer adequate solutions. AIM: To identify how patients with limited English and culturally different communication styles consult with general practitioners (GPs) in English, and to develop training strategies from both good practice and observed misunderstandings. METHODS: Randomly selected routine and emergency surgeries in 19 inner London general practices were video-recorded. The videos were viewed independently by 2 discourse analysts. Key consultations, across a wide range of English language ability, were selected and transcribed to analyse misunderstandings resulting from language/cultural differences. RESULTS: Of the 232 video recordings that were made, 20% were with patients with limited English and contained major and often extended misunderstandings. QUALITATIVE ANALYSIS: Four main categories of patient 'talk' contributing to misunderstandings are identified: (1) pronunciation and word stress; (2) intonation and speech delivery; (3) grammar, vocabulary and lack of contextual information; and (4) style of presentation. The importance of different styles of self-presentation by patients as the reason for misunderstandings is highlighted. On only 3 occasions were culturally specific health beliefs raised. CONCLUSION: It is routine for GPs in inner London practices to manage consultations with patients with culturally different communicative styles from their own. Specific training in identifying these problems and preventing/repairing them in the consultation is essential. This level of awareness-raising is more crucial than general discussions of culturally different health belief models.

Communication↗
PubMed2004

The long case.

BACKGROUND: The long case has been gradually replaced by the objective structured clinical examination (OSCE) as a summative assessment of clinical skills. Its demise occurred against a paucity of psychometric research. This article reviews the current status of the long case, appraising its strengths and weaknesses as an assessment tool. ISSUES: There is a conflict between validity and reliability. The long case assesses an integrated clinical reaction between doctor and real patients and has high face validity. Intercase reliability is the prime problem. As most examinations traditionally used a single case only, problems of content specificity and standardisation were not addressed. DISCUSSION: Recent research suggests that testing across more cases does improve reliability. Better structuring of tests and direct observation increases validity. Substituting standardised cases for real patients may be of little benefit compared to increasing the sample of cases. CONCLUSIONS: Observed long cases can be useful for assessment depending on the sample size of cases and examiners. More research is needed into the exact nature of intercase and interexaminer variance and consequential validity. Feasibility remains a key problem. More exploration of combined assessments using real patients with OSCEs is suggested.

Clinical Competence↗
PubMed2003

Effect of ethnicity on performance in a final objective structured clinical examination: qualitative and quantitative study.

OBJECTIVE: To assess the effect of ethnicity on student performance in stations assessing communication skills within an objective structured clinical examination. DESIGN: Quantitative and qualitative study. SETTING: A final UK clinical examination consisting of a two day objective structured clinical examination with 22 stations. PARTICIPANTS: 82 students from ethnic minorities and 97 white students. MAIN OUTCOME MEASURES: Mean scores for stations (quantitative) and observations made using discourse analysis on selected communication stations (qualitative). RESULTS: Mean performance of students from ethnic minorities was significantly lower than that of white students for stations assessing communication skills on days 1 (67.0% (SD 6.8%) and 72.3% (7.6%); P=0.001) and 2 (65.2% (6.6%) and 69.5% (6.3%); P=0.003). No examples of overt discrimination were found in 309 video recordings. Transcriptions showed subtle differences in communication styles in some students from ethnic minorities who performed poorly. Examiners' assumptions about what is good communication may have contributed to differences in grading. CONCLUSIONS: There was no evidence of explicit discrimination between students from ethnic minorities and white students in the objective structured clinical examination. A small group of male students from ethnic minorities used particularly poorly rated communicative styles, and some subtle problems in assessing communication skills may have introduced bias. Tests need to reflect issues of diversity to ensure that students from ethnic minorities are not disadvantaged.

Clinical Competence↗
PubMed2003

Achieving acceptable reliability in oral examinations: an analysis of the Royal College of General Practitioners membership examination's oral component.

BACKGROUND: The membership examination of the Royal College of General Practitioners (RCGP) uses structured oral examinations to assess candidates' decision making skills and professional values. AIM: To estimate three indices of reliability for these oral examinations. METHODS: In summer 1998, a revised system was introduced for the oral examinations. Candidates took two 20-minute (five topic) oral examinations with two examiner pairs. Areas for oral topics had been identified. Examiners set their own topics in three competency areas (communication, professional values and personal development) and four contexts (patient, teamwork, personal, society). They worked in two pairs (a quartet) to preplan questions on 10 topics. The results were analysed in detail. Generalisability theory was used to estimate three indices of reliability: (A) intercase (B) pass/fail decision and (C) standard error of measurement (SEM). For each index, a benchmark requirement was preset at (A) 0.8 (B) 0.9 and (C) 0.5. RESULTS: There were 896 candidates in total. Of these, 87 candidates (9.7%) failed. Total score variance was attributed to: 41% candidates, 32% oral content, 27% examiners and general error. Reliability coefficients were: (A) intercase 0.65; (B) pass/fail 0.85. The SEM was 0.52 (i.e. precise enough to distinguish within one unit on the rating scale). Extending testing time to four 20-minute oral examinations, each with two examiners, or five orals, each with one examiner, would improve intercase and pass/fail reliabilities to 0.78 and 0.94, respectively. CONCLUSION: Structured oral examinations can achieve reliabilities appropriate to high stakes examinations if sufficient resources are available.

Clinical Competence↗
PubMed2003

A discourse analysis study of 'good' and 'poor' communication in an OSCE: a proposed new framework for teaching students.

BACKGROUND: There is still a great deal to be learnt about teaching and assessing undergraduate communication skills, particularly as formal teaching in this area expands. One approach is to use the summative assessments of these skills in formative ways. Discourse analysis of data collected from final year examinations sheds light on the grounds for assessing students as 'good' or 'poor' communicators. This approach can feed into the teaching/learning of communication skills in the undergraduate curriculum. SETTING: A final year UK medical school objective structured clinical examination (OSCE). METHODS: Four scenarios, designed to assess communication skills in challenging contexts, were included in the OSCE. Video recordings of all interactions at these stations were screened. A sample covering a range of good, average and poor performances were transcribed and analysed. Discourse analysis methods were used to identify 'key components of communicative style'. FINDINGS: Analysis revealed important differences in communicative styles between candidates who scored highly and those who did poorly. These related to: empathetic versus 'retractive' styles of communicating; the importance of thematically staging a consultation, and the impact of values and assumptions on the outcome of a consultation. CONCLUSION: Detailed discourse analysis sheds light on patterns of communicative style and provides an analytic language for students to raise awareness of their own communication. This challenges standard approaches to teaching communication and shows the value of using summative assessments in formative ways.

Clinical Competence↗