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Introduction: Objective standardized teaching exercises (OSTEs) are widely used to develop professional competencies, especially in the health care professions. An OSTE involves exposing different providers to the same, time-limited scenario that is concurrently observed and/or recorded for either formative or summative evaluation. As there are limited resources available for creating a resident-specific OSTE, especially those applicable to family and community medicine residents, we created and evaluated a resident OSTE (R-OSTE) for second- and third-year family and community medicine residents., Methods: This R-OSTE involved two cases. The first featured Taylor, a third-year medical student resistant to feedback. The second featured Kris, a first-year resident nervous about approaching the attending on duty. Our R-OSTE had residents teaching interpersonal skills to trained actors in a standardized learner role., Results: Residents in the teaching role were formatively evaluated by peer observers (fellow residents) and standardized learners on interpersonal domains such as communication and professionalism. Learners gave residents an average performance rating of 4.9 on a 1 to 6 scale with 1 = Very Poor and 6 = Excellent . Residents also evaluated the OSTE itself, rating their experience on multiple teaching-related statements. Eighty-six percent of residents agreed this exercise was an appropriate development activity for family medicine residents. Overall, our R-OSTE was rated highly for relevance to teaching by the residents., Discussion: The residents were rated highly by both peer observers and standardized learners. However, there was little variability in peer observer scores, indicating the need for an alternative method of measurement., Competing Interests: None to report.

Objective: To assess communication and interpersonal skills (CIS) of radiology residents through faculty and standardised patients (SP)., Methods: In this day-long objective structured clinical examination (OSCE) in January 2009, 42 radiology residents took part at six stations in Karachi, each with a standardised patient and a faculty evaluator. Each encounter lasted 15 minutes followed by independent assessments of the residents by both the evaluators., Results: Based on rating-scale evaluations, all cases had satisfactory internal consistency (Cronbach's alpha 0.6 to 0.9). The alpha values were comparatively diminutive against the checklist scores. Correlation among faculty was 0.6 (p<0.001) with the use of both the checklist and the rating scale. Among standardised patient, intra-class correlation was 0.6 (p<0.001) for checklists and 0.7 (p=0.001) for rating scales. Moderate to strong correlations (r=0.6 to 0.9) existed between checklist and rating scores by the same type of evaluator. Correlations among the faculty and standardised patient using the same assessment tool were unimpressive., Conclusion: Both checklists and rating scales can serve as satisfactory assessment tools for communication and interpersonal skills using objective structured and clinical examination with the assistance of faculty and standardised patients.

The Manchester Child Attachment Story Task (MCAST) is a story stem method suitable for children aged about 4 to 8, aimed at assessing children's attachment representations with a doll-play format that is evaluated with a series of dimensional scales and classifications. Although this instrument has already been validated in previous studies, not all of the findings have been conclusive. The aims of the present study were (1) to examine the factor structure of the MCAST scales, and (2) to test the association between children's dichotomized MCAST classifications and factors with social competence, using the Social Competence and Behavior Evaluation Scale (SCBE) with a normative group of Italian preschoolers (age range 4.4 to 6.1). Results obtained from a sample of 64 children confirm the association of MCAST attachment classifications (security vs. insecurity and organization vs. disorganization) with both social skills and behavioral problems. Further independent studies on the variables analyzed are recommended for corroborating the findings obtained.

Purpose: To test the hypotheses that peer nomination is associated with measures of (1) academic performance, (2) empathy, (3) personality, and (4) specialty interest., Method: In 2007-2008, 255 third-year medical students at Jefferson Medical College were asked to nominate classmates they considered the best in six areas of clinical and humanistic excellence. The authors compared students who received nominations with those who did not, analyzing differences in academic performance, personality factors (empathy as measured by the Jefferson Scale of Empathy and personality qualities as measured by the Zuckerman-Kuhlman Personality Questionnaire), and specialty interests., Results: A comparison of the 155 students who received at least one peer nomination with the 100 students who received none found no significant difference in scores on objective examinations; nominated students, however, were rated significantly higher in clinical competence by faculty in six core third-year clerkships. Nominated students were also significantly more empathic and "active." In addition, a larger proportion of nominated students choose "people-oriented" (rather than "technology- or procedure-oriented") specialties., Conclusions: These results confirmed the hypotheses that peer nomination can predict clinical competence, empathy and other positive personal qualities, and interest in people-oriented specialties. Thus, in the assessment of medical students, peer nomination holds promise as a valid indicator of positive dimensions of professionalism.

Personal skills are now recognised to be important components of effective medical practice. These skills are explicit in the CANMED competencies from Canada, the recommendations of the ACGME from the United States and the recently revised 'Tomorrow's Doctors' paper from the Medical Council in the United Kingdom. The recommended core competencies which encompass personal skills in these international manifestos highlight a paradigm shift in a system which emphasised technical skills and knowledge to a recognition of the key role played by personal skills., (Copyright © 2010 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Professionalism is an inherent attribute to the practice of surgery. Historically, the importance of this quality arose later than the earliest three fundamental principles of medical knowledge, diagnostic ability, and technical skill. In the modern era, society has clearly come to require that its surgeons embrace professionalism as a fundamental principle. It now stands among the six core competencies that all United States training programs teach and measure. We define professionalism as the pursuit of excellence, the display of humanism, an altruistic commitment, and accountability to all interactions with society. Surgeons teach professionalism to their trainees every day, sometimes by formal curricula but more often by the unspoken and unsuspected modeling of behavior. These methods can be structured into a teaching program. To that program, active practice and engagement in continuous professionalism improvement ought to be added. In this way, a true method of professionalism training can be made that allows for formal assessment., (Copyright © 2011 Royal College of Surgeons of Edinburgh (Scottish charity number SC005317) and Royal College of Surgeons in Ireland. Published by Elsevier Ltd. All rights reserved.)

Background: The ability to communicate effectively with patients is an essential element of a physician's clinical expertise., Method: As part of the USMLE Step 2 Clinical Skills exam, standardized patients (SPs) provided ratings of communication and interpersonal skills (CIS) along three dimensions. Assessment data from a one-year (2006) cohort of graduates of international medical schools (IMGs) were analyzed and psychometric characteristics of the CIS measures are described., Results: Female and native English-speaking physicians received slightly higher CIS ratings than did males and examinees of other language backgrounds across all dimensions. However, no significant examinee by SP gender interaction effect was detected. Correlations with other measures support the construct validity of the CIS scale., Conclusions: Results of this preliminary study indicate that properly trained SPs can provide accurate and defensible ratings of IMGs' communication and interpersonal skills.

Purpose: To examine the effect of (1) gender on Step 2 Clinical Knowledge (CK) content area performance, (2) gender on the relationships between Step 1 scores and Step 2 CK content area performance, and (3) medical school characteristics on the relationships between examinee characteristics and Step 2 CK content area performance., Method: The sample included 23,538 examinees from 136 Liaison Committee on Medical Education-accredited medical schools/campuses. Descriptive statistics were computed, and a series of examinees-nested-in-schools hierarchical linear models was conducted., Results: Observed differences indicated that women generally outperformed men in most content areas and that controlling for Step 1 scores increased these gender-related score differences. Step 1 scores were more associated with Step 2 CK content area performance for men. School characteristics were generally unrelated to the relationships between examinee characteristics and Step 2 CK content area performance., Conclusions: While past research indicated that women outperformed men in some content areas, and men outperformed women in others, the current study revealed a somewhat different pattern, with women outperforming men in most content areas.

Objective: To objectively measure the effect of a pass-fail grading system on stress, mood, group cohesion, and test anxiety in medical students., Participants and Methods: Beginning with the class of 2006, the Mayo Medical School, Rochester, Minn, changed the grading system for first-year courses from a 5-interval grading system to a pass-fail grading system. Students in the previous class of 2005, who were graded using a 5-interval system during their first year of medical school, were compared with students in the class of 2006. Using a prospective study design, the 2 groups were compared at the end of both the first year and the second year of medical school on the Perceived Stress Scale, Profile of Mood States, Perceived Cohesion Scale, Test Anxiety Inventory, and (after year 2) the United States Medical Licensing Examination Step 1. Data collection occurred in 2002 and 2003 with the class of 2005 and in 2003 and 2004 with the class of 2006., Results: Students graded with the pass-fail system had less perceived stress (median, 15.0 vs 21.0; P-.01) and greater group cohesion (median, 34.5 vs 30.0; P=.02) at the end of their second year of coursework than their 5-interval graded peers. The pass-fail group had better mood (median, 46.5) than the graded group (median, 64.0), but this difference was not statistically significant (P=.07). No significant differences were found between the 2 groups in test-taking anxiety or in United States Medical Licensing Examination Step 1 board scores., Conclusion: Pass-fail grading may reduce stress and increase group cohesion in medical students compared with traditional 5-interval grading.

Many nuclear medicine technologists become clinical educators by chance, with little introduction to teaching methodologies and student learning styles. This means that most technologists teach students in the clinic by modeling the way in which they were taught in nuclear medicine school, a method that may not be effective for every student encountered. The purpose of this article is to examine how personality type can be used to improve clinical education effectiveness.

Assessment of the professional behaviour of doctors is increasingly recognized as an essential component of doctors' training (Ben-David et al., 2004) with equally important implications for doctors in permanent posts. TAB is a proforma for such assessment using a 360 degree process in which up to 15 colleagues of a doctor assess that doctor's professional behaviour. The pro forma is presented, together with discussion of the format and approach developed, with particular reference to the General Medical Council document "Good Medical Practice". We report on initial piloting of the approach in two UK NHS hospital trusts. In total 440 assessments of 30 doctors were completed. Data regarding intra-observer and inter-observer variation indicate that the process is reliable, practical and consistent. We believe this approach may represent a workable way ahead to promoting appropriate professional behaviour on the part of medical trainees and that it offers potential for re-validation of hospital consultants. There is a clear need for further development and evaluation of this approach, most notably its acceptability and value to all involved.

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.

Objective: To test the reliability of the 360-degree evaluation instrument for assessing residents' competency in interpersonal and communication skills., Method: Ten-item questionnaires were distributed to residents and evaluators at Monmouth Medical Center in Long Branch, New Jersey, in March/April, 2002. The scoring scale was 1-5; the highest score was 50. Data were maintained strictly confidential; each resident was assigned a code. Completed data sheets were collated by category and entered into a spreadsheet. The total and mean scores by each category of evaluator were calculated for each resident and a rank order list created. Shrout-Fleiss (model 2) intraclass correlation coefficients measured reliability of ratings within each group of evaluators. Reliability/reproducibility among evaluators' scores were tested by the Pearson correlation coefficient (p <.05)., Results: Intraclass correlation coefficients showed a narrow range, from.85-.54. The highest ranked resident overall ranked high and the lowest was low with most evaluators. The rank order among fellow residents was markedly different from other evaluator categories. Pearson correlation coefficients showed significant correlation between faculty and ancillary staff, (p =.002). Patients as evaluators did show intraclass correlation, but did not correlate significantly with other categories. Scores from colleagues correlated negatively with all other categories of evaluators., Conclusions: The 360-degree instrument appears to be reliable to evaluate residents' competency in interpersonal and communication skills. Information from the assessment may provide feedback to residents. Areas of improvement identified by the scores would suggest areas for improvement and further ongoing assessment.

The American Board of Medical Specialties described six core competencies considered essential elements of medical practice: patient care, medical knowledge, practice-based learning and improvement, interpersonal and communication skills, professionalism, and systems-based practice. In response, the Accreditation Council for Graduate Medical Education (ACGME) mandated that all residency programs assess trainees for the newly defined core competencies. Despite the mandate for including these six competencies in residency training, neither a specific curriculum nor a method to assess the outlined objectives has been developed by the ACGME. Instead, it is up to individual residency programs to document how they plan to incorporate and assess the core competencies in their programs. This article describes the potential use of direct observation to assess resident performance in the interpersonal skills core competency.

Purpose: The purpose of this study was to explore possible performance differences in interpersonal skills (IPS) ratings as a function of candidate and standardized patient (SP) gender., Methodology: The IPS scores and SP characteristics for 79,999 patient encounters were studied. This included 18,325 (20.36%) female candidate to female SP, 26,872 (29.86%) male candidate to female SP, 18,281 (20.31%) female candidate to male SP, and 16,521 (29.47%) male candidate to male SP interactions., Results: The analysis did not reveal a significant candidate gender by SP gender effect. There were no meaningful differences in IPS scores as a function of SP or candidate gender., Conclusions: The non-significant interaction between SP gender and candidate gender provides some evidence that male and female candidates are being assessed equivalently by male and female SPs. This result, combined with the extremely weak relationship between gender (candidate or SP) and IPS ratings, provides additional support for the fairness and defensibility of the IPS measures.

The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.

Professionalism is an important topic in medical education today. While much work has focused on defining professionalism and teaching medical students the appropriate interpersonal behaviours, relatively little research has looked at meaningful ways of assessing the relevant attributes.The Educational Commission for Foreign Medical Graduates (ECFMG®) clinical skills assessment (CSA®) uses standardised patients (SPs) to evaluate the readiness of graduates of international medical schools to enter accredited graduate training programmes in the USA. Doctor interpersonal skills, including professional qualities such as rapport, are evaluated as part of the CSA. Attentiveness, attitude and empathy, all facets of professional behaviour, are specifically targeted as part of the assessment.To date, over 35 000 candidates have been assessed, encompassing more than 370 000 individual SP encounters. Based on a 1-year cohort of examinees, the reliability of the individual professionalism-related component scores ranged from 0.61 to 0.70. Doctors who had graduated from medical school more recently, or were younger, generally obtained higher ratings. Professional qualities were only marginally related to measures of basic science and clinical science proficiency. Female candidates were rated significantly higher than male candidates on all dimensions.While some professional behaviours are probably best measured using formats such as surveys, self-assessment and critical incident techniques, certain aspects of the domain can be reliably and validly measured in SP examinations. [ABSTRACT FROM AUTHOR]