Measuring communication skills of medical students to patients with cancer

Progress in improving doctors' communication skills has been hampered by a lack of consistent theoretical underpinning. Resource constraints have contributed other problems, including difficulties in evaluating medical students' communication skills. Although use of unpaid evaluators has helped to alleviate these, differences between evaluator groups have led to a second generation of problems concerning accuracy and reliability. To address these issues, a conceptual clarification of doctor-patient communication is suggested. On its basis, seven communication skills needed by doctors are identified and then operationalized as a questionnaire measure of medical students' communication skills when talking to patients about cancer. An unusual feature is that the questionnaire can be used by lay and professional raters with only 1 hour of training. An empirical study was undertaken of the properties of the questionnaire. Generalizability theory, as well as more conventional approaches to reliability, was used to examine systematically the differences between simulator patient, psychologist and general practitioner raters. Results suggested that the questionnaire was of satisfactory overall reliability and validity. An unexpected finding was that more efficient future use of it might accrue if general practitioner raters are not used. Further uses of the questionnaire in theoretical and applied fields are suggested.