Promoting Value Through Patient-Centered Communication: A Multisite Validity Study of Third-Year Medical Students

Area of Science:

• Medical Education
• Health Professions Education
• Communication Skills Assessment

Background:

• Assessing medical students' ability to promote value in clinical encounters is crucial.
• Patient-centered communication is key to avoiding unnecessary tests and optimizing healthcare value.
• Standardized patient scenarios offer a controlled method for evaluating these skills.

Purpose of the Study:

• To establish validity evidence for a standardized patient scenario assessing medical students' value-promotion and patient-centered communication skills.
• To investigate how objective structured clinical examination (OSCE) implementation and curriculum factors influence student performance scores.

Main Methods:

• A standardized patient scenario was administered to 516 third-year medical students across 5 U.S. medical schools (2014-2017).
• Performance was evaluated using an 11-item checklist by centralized raters.
• Validity evidence was gathered through various statistical measures, including interrater reliability and generalizability coefficients.

Main Results:

• The mean checklist score was 0.85 (SD = 0.09), with excellent interrater reliability (0.87).
• Scores decreased with more OSCE stations (r = -0.15) but increased when used summatively (r = 0.26).
• Performance was not linked to curriculum time on high-value care but decreased after more clerkships (r = -0.12).

Conclusions:

• The scenario provides valid evidence for assessing medical students' value-promotion and patient-centered communication.
• OSCE structure and purpose significantly impact student scores.
• Clerkship experiences may not effectively reinforce high-value care principles taught in the curriculum.