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This article reports on the quality of care delivered by private and public providers of primary health care services in rural and urban India. To measure quality, the study used standardized patients recruited from the local community and trained to present consistent cases of illness to providers. We found low overall levels of medical training among health care providers; in rural Madhya Pradesh, for example, 67 percent of health care providers who were sampled reported no medical qualifications at all. What's more, we found only small differences between trained and untrained doctors in such areas as adherence to clinical checklists. Correct diagnoses were rare, incorrect treatments were widely prescribed, and adherence to clinical checklists was higher in private than in public clinics. Our results suggest an urgent need to measure the quality of health care services systematically and to improve the quality of medical education and continuing education programs, among other policy changes.

In this essay we set out clinical communication challenges in surgical oncology. We draw directly on relevant examples where they are available. Otherwise, we refer to the more generic surgical and medical literature. We offer 'macro' and 'micro' perspectives on clinical communication. That is, exploring communication challenges at the level of the organization and between individuals, doctors and patients and interprofessionally across different settings. Training content and methods are reported that address the complex communication challenges associated with surgical oncology. Innovations in simulation-based education offer exciting new opportunities for formative and summative assessment. We outline limitations of the essay and finally propose the content of a surgical oncology communication program., (Copyright © 2010. Published by Elsevier Ltd.)

Background: Simulated patients (SPs) play a critical role in medical education. The development of SP methodology has resulted in wide ranging responsibilities. For SPs to work effectively, we believed it was important to clearly articulate their responsibilities, and that this would be best achieved by consultation with all stakeholders-SPs, students, tutors, and administrators., Methods: As part of a quality assurance initiative, we designed a questionnaire and focus group study to explore stakeholders' perceptions of the responsibilities of SPs in teaching. Convenience and purposive sampling was used to recruit participants to questionnaires and focus groups, respectively. Data were analyzed thematically., Results: Eighty-six questionnaires were collected, and six focus groups were conducted. Five sets of guidelines on responsibilities were produced. In addition, guidelines were established for feedback that SPs and tutors could use to maximize impact., Discussion: The results highlight the complexity of SP-based teaching. Clarification of all stakeholders' responsibilities demonstrates the importance of a team approach to SP-based teaching. Focusing attention on just one set of stakeholder's responsibilities is unlikely to improve perception of quality. The process for developing the guidelines may be valuable for those who work with SPs. Stakeholder engagement is likely to ensure greater commitment than those developed by faculty.

Purpose: The Integrated Procedural Performance Instrument (IPPI) consists of clinical scenarios in which bench-top models are positioned to simulated patients. Trainees are required to perform technical skills while engaging with the patient. The purpose of this study was to determine whether an IPPI format examination could discriminate between different levels of trainees., Methods: Sixteen fourth-year medical students and 16 first-year surgery residents participated in 4 IPPI scenarios. Videotaped performances were scored by 2 blinded independent clinician raters on previously validated instruments: checklist of technical skills, Global Rating Scale of technical skills, and communication scale. We conducted separate mixed design analyses of variance (level x cases) on the 3 scales., Results: Residents performed better than medical students on the checklist (74% vs 60%, P < .05), the Global Rating Scale of technical skills (75% vs 56%, P < .01), and the coherence communication subscale (79% vs 69%, P < .05)., Conclusions: An IPPI examination discriminated between students' and residents' technical skills and coherence in communication skills. It also highlighted a potential gap in the training of residents' communication skills.

Background: Competency-based models of medical education require reliable and valid assessment of multiple physician roles., Aims: To develop and evaluate an objective structured clinical examination (OSCE) designed to assess 7 physician competencies (CanMEDS Roles)., Methods: Twenty four candidates from 4 neonatal-perinatal medicine training programs participated in a 10-station OSCE. Ten 5-point rating scales were developed and used to assess the CanMEDS Roles of Medical Expert, Communicator, Collaborator, Manager, Health Advocate, Scholar and Professional. Three descriptors of performance anchored the ratings. For each station, examiners completed appropriate CanMEDS ratings, a station-specific binary checklist and an overall process-related global rating. Trained standardized patients (SP) and standardized health professionals (SHP) completed rating scales that assessed verbal and non-verbal expression, empathy and coherence as well as the overall global rating., Results: Each station incorporated 3-5 physician Roles. Interstation alpha was 0.80 for checklist scores and 0.88 for examiners' overall global rating. Median interstation alpha for individual CanMEDS ratings was 0.72 (range 0.08-0.91). There were significant correlations between examiner Medical Expert scores and SP/SHP overall global scores and between examiner Communicator scores and 4 SP/SHP assessments of communication skills. Second year trainees' CanMEDS scores for each competency were significantly higher than those of first year trainees (p < 0.05)., Conclusions: The OSCE may be useful as a reliable and valid method of simultaneously assessing multiple physician competencies.