Communication skills assessment in the final postgraduate years to established practice: a systematic review.

INTRODUCTION: Communication breakdown is a factor in the majority of all instances of medical error. Despite the importance, a relative paucity of time is invested in communication skills in postgraduate curricula. Our objective is to systematically review the literature to identify the current tools used to assess communication skills in postgraduate trainees in the latter 2 years of training and in established practice. METHODS: Two reviewers independently reviewed the literature identifying communication skill assessment tools, for postgraduate trainees in the latter 2 years of training and in established practice following Preferred Reporting Items for Systematic Reviews and Meta-Analyses framework, and inclusion/exclusion criteria from January 1990 to 15 August 2014. DATABASES: PubMed/CINAHL/ERIC/EMBASE/PsycInfo/Psyc Articles/Cochrane. RESULTS: 222 articles were identified; after review, 34 articles fulfilled criteria for complete evaluation; the majority (26) had a high level of evidence scoring 3 or greater on the Best Evidence Medical Education guide. 22 articles used objective structured clinical examination/standardised patient (SP)-based formats in an assessment or training capacity. Evaluation tools included author-developed questionnaires and validated tools. Nineteen articles demonstrated an educational initiative. CONCLUSIONS: The reviewed literature is heterogeneous for objectives and measurement techniques for communication. Observed interactions, with patients or SPs, is the current favoured method of evaluation using author-developed questionnaires. The role of self-evaluation of skill level is questioned. The need for a validated assessment tool for communication skills is highlighted.

Assessment of competence in surgical skills using functional magnetic resonance imaging: a feasibility study.

BACKGROUND: Patient safety is fundamental to modern medical practice; safe surgery saves lives. Ensuring surgical competence is becoming more difficult at a time when surgeons are being trained in fewer hours. Accurate objective assessment of technical skills ability is lacking in standardization. Functional magnetic resonance imaging (fMRI) has a long history in neuroscience, psychiatry, and cognitive studies. Many studies have explored levels of perceived expertise in sports and musical ability. Little has been published on actual rather than perceived motor skills. This study sought to assess the feasibility of utilizing a novel assessment method by measuring blood oxygen level-dependent signal changes (BOLD) in specific brain regions via fMRI during a surgical skills task. METHODS: Images were acquired using fMRI in a pilot study of 9 subjects (3 experts, 3 intermediates, and 3 novices) when performing and imagining performing a basic surgical procedure: hand tying of surgical knots. Level of expertise was based on years of experience and clinical grade. The quality and quantity of knots were assessed objectively by 2 experts who were independent of the study and blinded to the ability of the candidate. The effect of subject head motion caused by the task itself was assessed. The efficacy of fMRI data analyses in removing artifacts caused by this noise source in the data was explored. RESULTS: Shifts of less than 1 voxel (3 × 3 × 3.55 mm(3)) were recorded in all participants and were successfully corrected in all cases in the fMRI preprocessing step. Decreased BOLD activity was observed in experts compared to novices when "knot tying" was compared with the control "finger tap." Increased BOLD activity was observed in experts compared with novices when "imagining a task" in the primary visual cortex, an area important in perceptual learning. Experts and intermediates performed consistently with 100% square knots. Novices had an average of 2 slip knots. Regarding knot quantity, the number of knots ranged from 14 to 26 in novices, 38 to 47 in intermediates, and 54 to 58 in experts. A Kruskal-Wallis rank sum test revealed that the difference between the 3 groups was statistically significant in the quantity of square knots tied (p = 0.147). Specific regions of interest identified concurred with findings of previous studies and included the left supramarginal, left rolandic operculum, and left postcentral regions. CONCLUSION: We found that fMRI is a feasible method of exploring actual and perceived motor skill abilities. Head motion during performance of a motor skill does not preclude the attainment of meaningful data. Larger numbers are needed to further investigate these early findings.

Tools used to assess medical students competence in procedural skills at the end of a primary medical degree: a systematic review.

The objective was to systematically review the literature to identify and grade tools used for the end point assessment of procedural skills (e.g., phlebotomy, IV cannulation, suturing) competence in medical students prior to certification. The authors searched eight bibliographic databases electronically - ERIC, Medline, CINAHL, EMBASE, Psychinfo, PsychLIT, EBM Reviews and the Cochrane databases. Two reviewers independently reviewed the literature to identify procedural assessment tools used specifically for assessing medical students within the PRISMA framework, the inclusion/exclusion criteria and search period. Papers on OSATS and DOPS were excluded as they focused on post-registration assessment and clinical rather than simulated competence. Of 659 abstracted articles 56 identified procedural assessment tools. Only 11 specifically assessed medical students. The final 11 studies consisted of 1 randomised controlled trial, 4 comparative and 6 descriptive studies yielding 12 heterogeneous procedural assessment tools for analysis. Seven tools addressed four discrete pre-certification skills, basic suture (3), airway management (2), nasogastric tube insertion (1) and intravenous cannulation (1). One tool used a generic assessment of procedural skills. Two tools focused on postgraduate laparoscopic skills and one on osteopathic students and thus were not included in this review. The levels of evidence are low with regard to reliability - κ = 0.65-0.71 and minimum validity is achieved - face and content. In conclusion, there are no tools designed specifically to assess competence of procedural skills in a final certification examination. There is a need to develop standardised tools with proven reliability and validity for assessment of procedural skills competence at the end of medical training. Medicine graduates must have comparable levels of procedural skills acquisition entering the clinical workforce irrespective of the country of training.