An Impact of Patient-physician Communication Curriculum on Students of Korean Medical School

Article information

J Korean Med. 2021;42(3):86-98

Publication date (electronic) : 2021 September 01

doi : https://doi.org/10.13048/jkm.21027

Hye-Yoon Lee ¹^,²

, Sunju Im ²

, So Jung Yune ²

, Sang Yeoup Lee ²

¹School of Korean Medicine, Pusan National University

²Department of Medical Education, Pusan National University School of Medicine

Correspondence to：임선주 경남 양산시 물금읍 부산대학로 49 (범어리, 부산대학교양산캠퍼스), 부산대학교 의과대학 의학교육학교실, Tel: +82-51-510-8021, Fax: +82-51-510-8125, E-mail: sunjuim11@hanmail.net

Received 2021 July 9; Accepted 2021 July 27.

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.

Keywords: patient-physician interaction; patient-physician communication; medical interview; medical education; Calgary-Cambridge guide to medical interview

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

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

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)

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)

Table 1

Objectives, Teaching Methods and Evaluation

Table 2

A Checklist Based on the Calgary-Cambridge Guide to the Medical Interview

Table 3

A Checklist of Patient-Physician Interaction in Korean Medical Licensing Examination

Table 4

Students’ Scores of Written Test

References

1. Beck RS, Daughtridge R, Sloane PD. Physician-patient communication in the primary care office: a systematic review. The Journal of the American Board of Family Practice 2002;15(1):25–38.

2. Farin E, Gramm L, Schmidt E. The patient–physician relationship in patients with chronic low back pain as a predictor of outcomes after rehabilitation. Journal of behavioral medicine 2013;36(3):246–258.

3. Thompson D, Ciechanowski PS. Attaching a new understanding to the patient-physician relationship in family practice. The Journal of the American Board of Family Practice 2003;16(3):219–226.

4. Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ: Canadian medical association journal 1995;152(9):1423.

5. Zachariae R, Pedersen CG, Jensen AB, Ehrnrooth E, Rossen PB, Von Der Maase H. Association of perceived physician communication style with patient satisfaction, distress, cancer-related self-efficacy, and perceived control over the disease. British journal of cancer 2003;88(5):658–665.

6. Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Annals of Internal medicine 1984;101(5):692–696.

7. Gelis A, Cervello S, Rey R, Llorca G, Lambert P, Franck N, Rolland B. Peer Role-Play for Training Communication Skills in Medical Students: A Systematic Review. Simul Healthc Apr. 2020;15(2):106–111. 10.1097/sih.0000000000000412.

8. Kakadia R, Chen E, Ohyama H. Implementing an online OSCE during the COVID-19 pandemic. Journal of dental education 2020;

9. Kim N-H, Cha H-Y, Shin S-W, Hong J-W. The effect of medical interview course in Korean medical school. The Journal of Korean Medicine 2012;33(1):121–135.

10. Sim SB, Kweon JH, Kim HW, Hong JW, Shin SW. Student satisfaction study of clinical skills training in Korean medical education. The Journal of Korean Medicine 2013;34(3):37–53.

11. Kweon JH, Sim SB, Kim EJ, Hong JW, Shin SW. Evaluation of the implementation of clinical performance examination in Korean medicine education. Journal of Physiology & Pathology in Korean Medicine 2018;32(1):51–61.

12. Cho CS. Student Satisfaction Study and Interrater Comparative Study on Patient-Physician Interaction Score of Clinical Performance Examination in Korean Medical Education. Korean Journal of Oriental Physiology & Pathology 2015;29(2):152–159.

13. Dean S, Zaslawski C, Roche M, Adams J. “Talk to Them”: Teaching communication skills to students of traditional chinese medicine. Journal of Nursing Education and Practice 2016;

14. Thomas PA, Kern DE, Hughes MT, Chen BY. Curriculum development for medical education: a six-step approach JHU Press; 2016.

15. Wool MS. Teaching and learning communication skills in medicine (2e). Health Expectations: An International Journal Of Public Participation In Health Care And Health Policy 2005;8(4):363.

16. Kurtz S, Silverman J, Draper J, Van Dalen J, Platt FW. Teaching and learning communication skills in medicine CRC press; 2017;

17. Miller GE. The assessment of clinical skills/competence/performance. Academic medicine 1990;65(9):S63–7.

18. David EK, Thomas PA. Curriculum development for medical education: a six-step approach JHU Press; 2016. p. 58–80. chap Chapter five. Step 4: Educational strategies.

19. Kim DH, Yoon HJ, Lee M-J, Ahn J-Y, Lee S-J, Suh Y-S. Comparison of Patient-Physician Interaction (PPI) Evaluation between Different Grade Medical Students. Korean journal of medical education 2010;22(3):169–176.

20. Park K-Y, Park H-K, Hwang H-S. Group randomized trial of teaching tobacco-cessation counseling to senior medical students: a peer role-play module versus a standardized patient module. BMC medical education 2019;19(1):1–9.

21. Bagacean C, Cousin I, Ubertini A-H, El Idrissi MEY, Bordron A, Mercadie L, Berthou C. Simulated patient and role play methodologies for communication skills and empathy training of undergraduate medical students. BMC medical education 2020;20(1):1–8.

22. Deveugele M, Derese A, De Maesschalck S, Willems S, Van Driel M, De Maeseneer J. Teaching communication skills to medical students, a challenge in the curriculum? Patient education and counseling 2005;58(3):265–270.

23. Evans BJ, Stanley RO, Mestrovic R, Rose L. Effects of communication skills training on students’ diagnostic efficiency. Medical education 1991;25(6):517–526.

24. Yedidia MJ, Gillespie CC, Kachur E, Schwartz MD, Ockene J, Chepaitis AE, Lipkin M Jr. Effect of communications training on medical student performance. Jama 2003;290(9):1157–1165.

25. Maguire P, Fairbairn S, Fletcher C. Consultation skills of young doctors: I--Benefits of feedback training in interviewing as students persist. Br Med J (Clin Res Ed) 1986;292(6535):1573–1576.

26. Lee YM, Kim BS. Association between student performance in a medical communication skills course and patient-physician interaction scores on a clinical performance examination. Korean Journal of Medical Education 2008;20(4):313–320.

27. Bowman F, Goldberg D, Millar T, Gask L, Mcgrath G. Improving the skills of established general practitioners: the long-term benefits of group teaching. Medical Education 1992;26(1):63–68.

28. Fallowfield L, Jenkins V, Farewell V, Solis-Trapala I. Enduring impact of communication skills training: results of a 12-month follow-up. British journal of cancer 2003;89(8):1445–1449.

Article information Continued

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

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

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)

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)

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
Initiating the session	Identifying the reason(s) for the consultation	CC2

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

Providing structure	Making organization overt	CC5
Providing structure	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
Closing the session	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