Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide

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Abstract

Background

The aim of the study was to confirm the validity and reliability of the Observation Scheme-12, a measurement tool for rating clinical communication skills.

Methods

The study is a sub-study of an intervention study using audio recordings to assess the outcome of communication skills training. This paper describes the methods used to validate the assessment tool Observation Scheme-12 by operationalizing the crude 5-point scale into specific elements described in a codebook. Reliability was tested by calculating the intraclass correlation coefficients for interrater and intrarater reliability.

Results

The validation of the Observation Scheme-12 produced a rating tool with 12 items. Each item has 0 to 5 described micro-skills. For each item, the codebook described the criteria for delivering a rating from 0 to 4 depending on how successful the different micro-skills (or number of used jargon words) was accomplished. Testing reliability for the overall score intraclass correlation coefficients was 0.74 for interrater reliability and 0.86 for intrarater reliability. An intraclass correlation coefficient greater than 0.5 was observed for 10 of 12 items.

Conclusion

The development of a codebook as a supplement to the assessment tool Observation Scheme-12 enables an objective rating of audiotaped clinical communication with acceptable reliability. The Observation Scheme-12 can be used to assess communication skills based on the Calgary-Cambridge Guide.

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Most cited references 24

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How does communication heal? Pathways linking clinician-patient communication to health outcomes.

Richard L. Street, Gregory Makoul, Neeraj K. Arora … (2009)

Although prior research indicates that features of clinician-patient communication can predict health outcomes weeks and months after the consultation, the mechanisms accounting for these findings are poorly understood. While talk itself can be therapeutic (e.g., lessening the patient's anxiety, providing comfort), more often clinician-patient communication influences health outcomes via a more indirect route. Proximal outcomes of the interaction include patient understanding, trust, and clinician-patient agreement. These affect intermediate outcomes (e.g., increased adherence, better self-care skills) which, in turn, affect health and well-being. Seven pathways through which communication can lead to better health include increased access to care, greater patient knowledge and shared understanding, higher quality medical decisions, enhanced therapeutic alliances, increased social support, patient agency and empowerment, and better management of emotions. Future research should hypothesize pathways connecting communication to health outcomes and select measures specific to that pathway. Clinicians and patients should maximize the therapeutic effects of communication by explicitly orienting communication to achieve intermediate outcomes (e.g., trust, mutual understanding, adherence, social support, self-efficacy) associated with improved health.

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The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes.

Andrew Silverman, S L Kurtz (1996)

Effective communication between doctor and patient is a core clinical skill. It is increasingly recognized that it should and can be taught with the same rigour as other basic medical sciences. To validate this teaching, it is important to define the content of communication training programmes by stating clearly what is to be learnt. We therefore describe a practical teaching tool, the Calgary-Cambridge Referenced Observation Guides, that delineates and structures the skills which aid doctor-patient communication. We provide detailed references to substantiate the research and theoretical basis of these individual skills. The guides form the foundation of a sound communication curriculum and are offered as a starting point for programme directors, facilitators and learners at all levels. We describe how these guides can also be used on an everyday basis to help facilitators teach and students learn within the experiential methodology that has been shown to be central to communication training. The learner-centred and opportunistic approach used in communication teaching makes it difficult for learners to piece together their evolving understanding of communication. The guides give practical help in countering this problem by providing: an easily accessible aide-mémoire; a recording instrument that makes feedback more systematic; and an overall conceptual framework within which to organize the numerous skills that are discovered one by one as the communication curriculum unfolds.

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Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?

Michele Heisler, Douglas Robinson, Peter Ubel … (2009)

To be able to adhere to discharge instructions after a visit to the emergency department (ED), patients should understand both the care that they received and their discharge instructions. The objective of this study is to assess, at discharge, patients' comprehension of their ED care and instructions and their awareness of deficiencies in their comprehension. We conducted structured interviews of 140 adult English-speaking patients or their primary caregivers after ED discharge in 2 health systems. Participants rated their subjective understanding of 4 domains: (1) diagnosis and cause; (2) ED care; (3) post-ED care, and (4) return instructions. We assessed patient comprehension as the degree of agreement (concordance) between patients' recall of each of these domains and information obtained from chart review. Two authors scored each case independently and discussed discrepancies before providing a final concordance rating (no concordance, minimal concordance, partial concordance, near concordance, complete concordance). Seventy-eight percent of patients demonstrated deficient comprehension (less than complete concordance) in at least 1 domain; 51% of patients, in 2 or more domains. Greater than a third of these deficiencies (34%) involved patients' understanding of post-ED care, whereas only 15% were for diagnosis and cause. The majority of patients with comprehension deficits failed to perceive them. Patients perceived difficulty with comprehension only 20% of the time when they demonstrated deficient comprehension. Many patients do not understand their ED care or their discharge instructions. Moreover, most patients appear to be unaware of their lack of understanding and report inappropriate confidence in their comprehension and recall.

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Author and article information

Contributors

Else Dalsgaard Iversen:

ORCID: http://orcid.org/0000-0002-8065-6063

else.iversen@rsyd.dk

Journal

Journal ID (nlm-ta): BMC Med Educ

Journal ID (iso-abbrev): BMC Med Educ

Title: BMC Medical Education

Publisher: BioMed Central (London )

ISSN (Electronic): 1472-6920

Publication date (Electronic): 6 May 2020

Publication date PMC-release: 6 May 2020

Publication date Collection: 2020

Volume: 20

Electronic Location Identifier: 140

Affiliations

[1 ]GRID grid.459623.f, ISNI 0000 0004 0587 0347, Health Services Research Unit, , Lillebaelt Hospital, ; Beriderbakken 4, DK-7100 Vejle, Denmark

[2 ]GRID grid.10825.3e, ISNI 0000 0001 0728 0170, Institute for Regional Health Research, , University of Southern Denmark, ; Winsløwparken 19, Odense, Denmark

[3 ]OPEN, Odense Patient data Explorative Network, J. B. Winsløws Vej 9a, 5000 Odense, Denmark

[4 ]GRID grid.459623.f, ISNI 0000 0004 0587 0347, Department of Paediatrics, , Lillebaelt Hospital, ; Sygehusvej 24, DK-6000 Kolding, Denmark

[5 ]GRID grid.5510.1, ISNI 0000 0004 1936 8921, Institute of Clinical Medicine, Campus Ahus, , University of Oslo, ; 1478 Nordbyhagen, Oslo, Norway

[6 ]GRID grid.411279.8, ISNI 0000 0000 9637 455X, HØKH, , Akershus University Hospital, ; Sykehusveien 25, 1478 Nordbyhagen, Norway

[7 ]GRID grid.459623.f, ISNI 0000 0004 0587 0347, Department of Gastrointestinal Surgery, , Lillebaelt Hospital, ; Sygehusvej 24, DK-6000 Kolding, Denmark

[8 ]GRID grid.7143.1, ISNI 0000 0004 0512 5013, Department of Oncology, , Odense University Hospital, ; J. B. Winsløws Vej 4, DK-5000 Odense, Denmark

Author information

Else Dalsgaard Iversen http://orcid.org/0000-0002-8065-6063

Article

Publisher ID: 2050

DOI: 10.1186/s12909-020-02050-3

PMC ID: 7201796

PubMed ID: 32375756

SO-VID: 8868e177-7f0a-46db-a276-4402a1528823

License:

Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

History

Date received : 14 October 2019

Date accepted : 22 April 2020

Funding

Funded by: Region Syddanmark

Award ID: J.nr. 15/51286

Award Recipient : Else Dalsgaard Iversen

Funded by: FundRef http://dx.doi.org/10.13039/501100006356, Syddansk Universitet;

Funded by: Lillebaelt Hospital

Custom metadata

ScienceOpen disciplines: Education

Keywords: assessment tool,communication skills training,audio recordings,calgary-cambridge guide,interrater reliability,codebook,observation scheme-12

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ScienceOpen disciplines: Education

Keywords: assessment tool, communication skills training, audio recordings, calgary-cambridge guide, interrater reliability, codebook, observation scheme-12

Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide

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Abstract

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Special series: Public Communication of Science and Technology

Most cited references 24

How does communication heal? Pathways linking clinician-patient communication to health outcomes.

The Calgary-Cambridge Referenced Observation Guides: an aid to defining the curriculum and organizing the teaching in communication training programmes.

Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand?

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