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JKM > Volume 42(3); 2021 > Article
Lee, Im, Yune, and Lee: An Impact of Patient-physician Communication Curriculum on Students of Korean Medical School

Abstract

Objectives

This study aims to evaluate the impact of patient-physician communication curriculum on students of Korean medical school in terms of cognitive, affective, and psychomotor level of communication skills.

Methods

A communication curriculum was developed considering COVID-19 pandemic situation. Lectures, peer role-play, open interview with standardized patient (SP), discussion and feedback were conducted by online, and face-to-face 1:1 SP-interview was performed. Scores of written test, peer role-play of medical communication, SP-interview, self-evaluation on one’s interview with real patients in clinical clerkship, and questionnaire of importance were collected and analyzed.

Results

Converted to 100 point scale, the mean score of written test (cognitive level) was 91.2 while that of importance questionnaire (affective level) was 77.5. The mean scores of psychomotor level were 72.5, 77.5, and 62.5 for peer role-play, SP-interview, and real patient interview in clerkship, respectively.

Conclusions

Students’ performance is lower in higher level of competence. Curriculums should provide more opportunities of practices to students, and include evaluation focusing on performance skills.

Fig. 1
Scores of Performance in Peer Role-Play According to the Subcategories of Calgary-Cambridge Checklist
A, Proportion of students’ peer role-play scores by subcategories.
The red line indicates average of scores for all categories (2.9)
The numbers on the graph indicate the number of students for each category
The score of each category ranges 1 (poor) to 4 (very good).
B, Mean scores of peer role-play by subcategories.
The score of each category ranges 1 (poor) to 4 (very good).
CC, Code of Calgary-Cambiridge checklist
jkm-42-3-86f1.gif
Fig. 2
Scores of Interview with Standardized Patients according to PPI Checklist.
A, Proportion of students’ SP-interview scores.
The red line indicates average of scores for all categories (3.3).
The numbers on the graph indicate the number of students for each category
B, Mean scores of SP-interview
The score of each category ranges 1 (poor) to 4 (very good).
L, code of PPI checklist
SP, standardized patient; PPI, patient-physician interaction
jkm-42-3-86f2.gif
Fig. 3
Importance and Performance Analysis by Subcategories of Calgary-Cambridge Guide to Medical Interview
Reference lines indicate the means of importance and performance; Numbers on the scatter plot indicate the codes of Calgary-Cambridge checklist.
Scores range 1 (not important or poor performance) to 4 (very important or very good)
jkm-42-3-86f3.gif
Fig. 4
Proportion of Students by Scores of Importance (A) And Performance (B)
CC, Code of Calgary-Cambiridge checklist
Numbers on the graph indicate the number of students
Scores range 1 (not important or poor performance) to 4 (very important or very good)
jkm-42-3-86f4.gif
Table 1
Objectives, Teaching Methods and Evaluation
Objectives Teaching methods Evaluation
Cognitive By the end of the ‘medical conversation’ class, each fourth-year student will have achieved cognitive proficiency in defining communication skills based on the ‘Calgary-Cambridge guide to the medical interview’ as listed below.
  • - Listens

  • - Repetition (paraphrasing)

  • - Summarizing

  • - Encouraging patients

  • - Non-verbal behavior

  • - Contracting

Lecture (material: Calgary-Cambridge guide to the medical interview) Written test
Affective By the end of the ‘medical conversation’ class, each fourth-year student will rate the importance of communication at least 3 out of 4. Lecture
PRP
Reflection on PRP of oneself
Feedback on PRP from peers and professors
Discussion on PRP
SP interview and discussion
Patient interview in clerkship
A self-evaluation on perception of importance during clerkship
Psychomotor (skill or competence) During the curriculum, each student will demonstrate in peer role-pay a medical interview that incorporates the communication skills listed below.
  • - Establishing rapport

  • - Gathering information

  • - Providing structure

  • - Aiding accurate recall and understanding

  • - Incorporating the patient’s perspective

  • - Shared decision making

  • - Forward planning

  • - Ensuring appropriate point of closure

PRP
Reflection on PRP of oneself
Feedback on PRP from peers and professors
Discussion on PRP
SP interview and discussion
Patient interview in clerkship
Scores of PRP video
PPI scores in SP interview formative evaluation
PPI scores in SP interview summative evaluation
Self-evaluation on ‘competence’ based on clerkship experience

PRP, peer role-play; PPI, patient-physician interaction; SP, standardized patient;

Table 2
A Checklist Based on the Calgary-Cambridge Guide to the Medical Interview
Main category Subcategory Code
Initiating the session Establishing initial rapport CC1
Identifying the reason(s) for the consultation CC2

Gathering information Exploration of patient’s problems CC3
Additional skills for understanding the patient’s perspective CC4

Providing structure Making organization overt CC5
Attending to flow CC6

Building relationship Using appropriate non-verbal behavior CC7
Developing rapport CC8
Involving the patient CC9

Explanation and planning Providing the correct amount and type of information CC10
Aiding accurate recall and understanding CC11
Achieving a shared understanding: incorporating the patient’s perspective CC12
Planning: shared decision making CC13

Closing the session Forward planning CC14
Ensuring appropriate point of closure CC15
Table 3
A Checklist of Patient-Physician Interaction in Korean Medical Licensing Examination
Category Code
Efficiently asked and listened to the patient’s story. L1
The patient’s thoughts and background were effectively identified. L2
Explained in an easy-to-understand manner for the patient. L3
The doctor tried to form a good relationship with the patient. L4
The interview was conducted systematically. L5
The attitude of physical examination was good. L6
Table 4
Students’ Scores of Written Test
Total items (50 items) Items of application (10 itmes)

Category No. of items Mean (SD) min max No. of items Mean (SD)
CC1 3 99.2 (5.2) 66.7 100.0 1 85.1
CC2 3 76.4 (17.1) 33.3 100.0 1 31.9
CC3 10 94.1 (9.2) 70.0 100.0 2 71.3 (34.8)
CC4 2 76.8 (27.6) 0.0 100.0 1 51.1
CC5 2 96.3 (13.2) 50.0 100.0 0 NA
CC6 1 100.0 (0) 100.0 100.0 0 NA
CC7 2 100.0 (0) 100.0 100.0 0 NA
CC8 2 95.1 (15) 50.0 100.0 0 NA
CC9 3 100.0 (0) 100.0 100.0 0 NA
CC10 5 88.3 (10.9) 60.0 100.0 1 38.3
CC11 5 94.1 (9.2) 80.0 100.0 1 74.5
CC12 5 87.8 (14.7) 40.0 100.0 1 57.4
CC13 4 86.0 (21) 25.0 100.0 1 61.7
CC14 3 86.2 (19.7) 33.3 100.0 1 59.6
Total 50 91.2 (7.3) 68.0 100.0 10 69.0 (25.0)

CC, Code of Calgary-Cambridge guide to medical interview

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