Can written communication skills be tested in an objective structured clinical examination format?

To design and evaluate an objective structured clinical examination (OSCE) station on dictating a consult letter as part of a formative OSCE for internal medicine residents.

A 22-minute station for the dictation of a consult letter was included in a ten-station OSCE. Two raters completed a 34-item rating scale for 36 letters. The rating scale involved content and style. The station's score was derived from an overall rating of each section of the letter (history, physical examination, impression/plan) and a global rating of the complete letter. The exam also contained a physical exam station on the same patient problem and a verbal communication station. Residents provided written feedback following the station.

The inter-rater reliability for the station's score was .72. The generalizability coefficient for the two-rater four-part rating scale was .79. The correlation between the consult letter and the total exam scores was .56, the highest for all ten stations. A significant correlation existed between the verbal communication station's score and the letter station's score (r =.37, p <.005), but no correlation occurred between the physical exam station's score on a similar patient problem and the letter station's score. The feedback from residents was favorable regarding amount of information provided and time allotted.

An OSCE station is a feasible way to examine written communication skills. Letter-writing skills appear to be distinct from knowledge (physical exam station), but somewhat linked to verbal communication skills.