의과대학생의 의사소통 행동과 태도 평가: Amsterdam attitudes and communication scale의 신뢰도 추정

의과대학생의 의사소통 행동과 태도 평가: Amsterdam attitudes and communication scale의 신뢰도 추정

Assessment of medical students' communicative behaviour and attitudes: estimating the reliability of the use of the Amsterdam attitudes and communication scale through generalisability coefficients.

de Haes JC1, Oort F, Oosterveld P, ten Cate O.

1Department of Medical Psychology, Academic Medical Centre, University of Amsterdam, P.O. Box 22700, The Netherlands. j.c.dehaes@amc.uva.n

일반적으로 적절한 태도와 의사소통 기술은 의학교육에서 필수적 목표 중 하나이다. Amsterdam attitude and communication scale(AACS)는 의과대학생들의 의사소통 기술과 전문직업적 태도를 평가하기 위해 개발되었다. 더 구체적으로는 임상실습을 도는 학생을 평가하여 의료전문직에 적합한 태도를 기르게 해주는 목적이 있다. AACS는 아홉 개 영역을 커버한다. 또한 학생의 수행능력에 대한 overall 판단이 포함된다. 이 논문은 AACS를 이용한 결과의 reliability에 대한 첫 번째 연구이다.

자료는 AACS수련 프로그램중에 수집되었으며, senior medical and nursing staff members로부터 수집하였다. 참가자들은 환자를 면담하는 학생의 세 개의 비디오테이프를 보았다. 비디오테이프에 대해서는 AACS의 첫 번째 네 개 영역과 overall judgement가 relevant했다. Generalisability Theory를 적용하여 AACS의 reliability를 예측할 수 있었으며, 충분한 reliability를 얻기 위해 필요한 rater의 수를 알 수 있었다.

만약 임상실습을 도는 학생의 행동이 여섯 명의 평가자에 의해서 평가된다면, 총괄평가는 상당히 정확하다. AACS의 전체를 모두 사용하여 10개 아이템을 다 사용한다면 같은 수의 평가자가 필요하다. AACS item각각에 대한 점수는 충분히 reliable하지 않았다. 종합하면, 이 결과로부터 충분한 평가자와 충분한 수의 item을 사용한다면 학생의 행동을 reliable하게 평가할 수 있다.

Appendix A. Behavioural operationalisation of dimensions, an example

A.1. Adequate information gathering

The doctor needs to gather information to reach a diagnosis and to develop an adequate treatment plan. Two perspectives can be distinguished in information gathering. 

• The first entails the mapping of symptoms and complaints from a medical perspective. In such case the doctor knows what is relevant. 
• Secondly, one can gather information from the patient’s perspective. This is appropriate when emotions, preoccupations, ideas, values and expectations of the patient should be clarified. It will improve insight, clarify the reason for encounter and enhance the possibilities of support.

Signs of adequate information gathering

•  Explaining the reason for questions
•  Posing open directive questions
•  Posing one question at the time
•  Posing simple questions
•  Formulations should be simple
•  Use of stimulating sentences in between
•  Check the patient’s understanding
•  Use of a professional, yet not an unfriendly tone
•  Take a welcoming position non-verbally (eye contact, take position towards patient)
•  Display interest in the answers given
•  Prompting/asking for clarification
•  Not accepting vague information
•  Reflection of facts and feelings
•  Summarising
•  Reacting to verbal and non-verbal cues

Signs of inadequate information gathering

•  Use of medical jargon
•  Posing two or more questions at the same time
•  Asking successive questions too quickly
•  Giving little room for an answer
•  Interrupting or breaking off the conversation
•  Posing leading questions
•  Conveying a negative judgement in between the lines (about a patient or his/her reactions)
•  Premature interpretation
•  Being evasive about sensitive matters

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Patient Educ Couns. 2001 Oct;45(1):35-42.

Assessment of medical students' communicative behaviour and attitudes: estimating the reliability of the use of the Amsterdam attitudes and communication scale through generalisability coefficients.

de Haes JC1, Oort F, Oosterveld P, ten Cate O.

Author information

Abstract

It is widely accepted that adequate attitudes and communicative skills are among the essential objectives in medical education. The Amsterdam attitude and communication scale (AACS) was developed to assess communicative skills and professional attitudes of medical students. More specifically, it was designed to evaluate the clinical behaviour of clerks to establish their suitability for the medical profession. The AACS covers nine dimensions. Moreover, an overall judgement of the student's performance is included. The present paper reports first results on the reliability of the use of the AACS. Data were collected in the course of an AACS training programme for future judges: senior medical and nursing staff members (N=98). Participants judged three videotapes of clerks interviewing patients at the bedside. For the assessment of videotapes, the first four dimensions of the AACS and the overall judgement are relevant. By applying Generalisability Theory to the training data we can forecast the reliability of the AACS in practice and gain insight in the number of raters that is needed to achieve sufficient reliability in clinical practice. If clerk behaviour is rated by six judges, summative assessment is sufficiently precise, i.e. <0.25. When using the full AACS, covering 10 items, the same number of judges is needed. Scores on individual AACS items are not sufficiently reliable. In conclusion, the results indicate that students' behaviour can be evaluated in a reliable manner using the AACS as long as enough judges and items are involved.

PMID:

 

11602366

 

[PubMed - indexed for MEDLINE]