Business Research Project

The performance of physicians in their day-to-day clinical practices has become an area of intense public interest. Both patients and health care purchasers want more effective means of identifying excellent clinicians and a variety of organizations are discussing and implementing plans for assessing the performance of individual clinicians.

In the article, Prospects and Barriers, it was reviewed that the current state of physician clinical performance assessment with a focus on its usefulness for competency assessment needs improvement. It described recommendations for a physician clinical performance assessment system for the purpose to identify ways in which current

methods of performance assessment, in the vicinity of communication of medical students can help improve effectiveness, efficiency and patient care. It is evident that important technical barriers stand in the way of using physician clinical performance assessment for evaluating the competency of individual physicians. Overcoming these barriers will require considerable additional research and development. Even then, for some uses, physician clinical performance assessment at the individual physician level may be technically impossible to accomplish in a valid and fair way.

During a control study, in an attempt to find ways to improve communication skills and overall medical performance amongst physicians; a study was conducted within three U.S. medical schools and its students. The purpose was to determine whether

communications training for medical students improve specific competencies known to affect outcomes of care. The study and results were conducted as followed:

Design and Setting: A communications curriculum instituted in three U.S. medical schools was evaluated with objective structured clinical examinations. The objected structured clinical examinations were administered to a comparison cohort of students in the year before the intervention.

Participants: One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001).

Intervention: Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development.

Main Outcome Measures: Standardized patients assessed student performance on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance.

Results: Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE 65.4% vs. 60.4%; 5% difference.

Conclusions: Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making--tasks