Daniel Duffy - Academia.edu (original) (raw)

Papers by Daniel Duffy

T he structure, process, and outcomes of internal medicine residency training have concerned the ... more T he structure, process, and outcomes of internal medicine residency training have concerned the profession for over 20 years. Over the last decade the initiative to move to outcomes-based education redefined the competencies physicians should obtain during training. The core principle of outcomes-based education is the objective demonstration that a graduating trainee, whether from medical school or a residency, possesses the knowledge, skills, and attitudes necessary to progress to the next stage of his or her professional career. The Accreditation Council for Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) have defined core competencies for physicians shown in Table 1. While both the ACGME and IOM provide a framework for the desired outcomes, medical educators bear the burden of designing the structures and processes to achieve them. Educators face several key challenges in redesigning residency programs. First, residency programs must prepare trainees for ...

Journal of graduate medical education, 2013

Future physicians may not be prepared for the challenges of caring for the growing population of ... more Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic "gulf" between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. Residents rated most components of the Academy as "very good" or "exce...

Journal of graduate medical education, 2009

The Physician and Sportsmedicine, 2000

Despite the demands of a busy office setting, a brief physician counseling session about exercise... more Despite the demands of a busy office setting, a brief physician counseling session about exercise can be highly effective and well worth the precious time. Components include delivering a clear message about exercise, stepping back to assess the patient's readiness to change, and using the patient's cues to set an activity agenda. Physician counseling about exercise is crucial to improving patients' health status and to the success of the several activity recommendations contained in the federal government's Healthy People 2010 report.

Perspectives in Biology and Medicine, 2007

Few question the need for continuous professional development throughout a physician's career, bu... more Few question the need for continuous professional development throughout a physician's career, but rapid changes in health care are creating demand for physicians to acquire new knowledge, skills, and attitudes to implement quality improvement in clinical practice.The Internet and World Wide Web are technologies that have the potential to facilitate deep change in physician practice and lifelong learning. This paper describes how the American Board of Internal Medicine (ABIM) has utilized the Web and the Internet to engage physicians in the competencies of practicebased learning and improvement and systems-based practice. Specifically, we describe how the ABIM developed and implemented Web-based practice improvement modules (PIMs) to help physicians measure and improve their clinical practice.

Journal of General Internal Medicine, 2006

The Institute of Medicine's first simple rule for quality health care is a long-term healing rela... more The Institute of Medicine's first simple rule for quality health care is a long-term healing relationship; and the first aim for a quality health care system is patient-centered care. 1 The Association of American Medical Colleges' Medical School Objective Project urged faculties to teach interpersonal and communication skills. 2 The Accreditation Council for Graduate Medical Education accredits residency programs based, in part, on their demonstration of residents' competence in interpersonal and communication skills. 3 Similarly, the American Board of Medical Specialties' member boards include communication skills in the criteria for certification and recertification. 4 Yet the scientific and theoretical basis for these recommendations remains sparse. The proceedings of the conference, ReForming Relationships in Health Care: Creating a National Research Agenda for Relationship-Centered Care, published in this supplement contributes to rectifying this deficiency. The plenary papers explain how, why, and what makes healing relationships succeed and fail. The conference outlines an ambitions agenda of research questions about the centerpiece of all health carethe healing relationship. The answers to these questions promise to inform healers, teachers of healers, evaluators of the quality of healing, and social institutions that support healing. The philosophy of medical care called relationship-centered care (RCC) provides the ideological glue that holds these papers together. 5 On superficial inspection RCC appears to be a synonym for its antecedent, and possibly more familiar patient-centered care or the humanistic qualities of Care. Such short shrift would be unfortunate, for RCC plows new ground by expanding the concept of the physician patient relationship to one that includes the personhood of both the patient and the physician, acknowledges the central role played by the emotions of both parties in the relationship and the fact that the relationship is shaped by reciprocal influence rather than only by humanistic, but still largely unidirectional, therapeutic ministrations. Were the RCC philosophy to stop with expanding the ideas about the physician patient relationship, it still would be a substantial advance; however, its authors go further. They promote the idea that health care emerges from the relationships between all of the people who make up the institutions and communities responsible for health care. In all of these relationships, the personhood, emotions, and reciprocal influences of everyone on everyone else actively shape the quality of care, the experience of health and illness, and satisfaction of everyone involved. 6 At first blush, RCC appears to challenge the basic tenants of traditional medical professionalism. It displaces the old idea that physicians be compassionate yet somewhat depersonal

Journal of General Internal Medicine, 2008

Journal of General Internal Medicine, 2005

Journal of Continuing Education in the Health Professions, 2006

Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and re... more Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence in practice-based learning and improvement and systems-based practice. Methods: Sixteen practicing general internists and endocrinologists with 10-year time-limited certification participated in a beta test of the ABIM's diabetes practice improvement module (PIM) as part of their recertification program. A PIM consists of a self-directed medical record audit, practice system survey, and patient survey. A quality improvement education specialist from the Connecticut Quality Improvement Organization provided on-site and distance consultation on quality improvement methods and tools. An independent audit assessed the reliability of physician self-audit. Qualitative interviews were conducted at 2 time points to assess for physician satisfaction and behavioral change in quality improvement. Results: Fourteen physicians completed the diabetes PIM. All but 1 physician found the medical record audit to provide important information about the practice. Of the 11 physicians who completed a follow-up interview, 10 stated that the quality improvement education specialist helped improve their practice. Discussion: Self-assessment using the ABIM diabetes PIM as part of recertification provides valuable practice information and can lead to meaningful behavioral change by physicians. Collaboration with an educator in quality improvement appears to facilitate the effects of the practice improvement module. Future work should investigate the effect on patient outcomes.

Journal of Continuing Education in the Health Professions, 2008

Background: Quality measurement and improvement in practice are requirements for Maintenance of C... more Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs.

JAMA, 2006

Blueprint for establishing effective postbaccalaureate medical school pre-entry program for educa... more Blueprint for establishing effective postbaccalaureate medical school pre-entry program for educationally disadvantaged students.

Annals of Internal Medicine, 2004

Annals of Internal Medicine, 2005

Choudhry and colleagues' paper may be technically flawed, but more important, in our view it is p... more Choudhry and colleagues' paper may be technically flawed, but more important, in our view it is potentially destructive (1). Behind the mask of "evidence-based medicine," the authors reviewed 59 articles, selected by their own peculiar process from hundreds of potential papers relevant to the subject. They then analyzed this sample according to 4 criteria: knowledge; adherence to standards of practice for diagnosis, screening, and prevention; adherence to standards of appropriate therapy; and outcomes. They concluded that physicians who have been practicing longer may be at risk for providing lower-quality care and may need quality improvement interventions. This "systematic review" was not in the least systematic. Of 245 articles retrieved by an Internet search engine, the authors excluded 167 for various arbitrary reasons and excluded 3 others for reasons that were not characterized. To the 78 papers that remained, the authors added 9 articles from their personal archives and 35 more from a reference list search. Of the 122 papers discovered by this circuitous route, the authors excluded 63 more because the practice variation or outcomes were not clearly related to quality of care or because the relationship between length of time in practice or physician age and outcomes was not reported. Four additional papers were excluded for other reasons. This extraordinary process yielded the 59 articles that were the subject of the paper. All 4 of the authors' criteria indicate the core weakness of measuring quality in an evidence-based manner. The first criterion, knowledge, would be more accurately described as "information." If patients desired and sought only information, they could consult the Internet rather than a physician. The next 2 criteria, adherence to standards of practice for diagnosis, screening, and prevention and adherence to standards of practice for therapy, are also superficial gauges of quality medicine. Patients do not seek consultation for a more fastidious application of standards; they look to us for a wise, compassionate analysis of their problem. Certainly, a patient would be in better hands with a doctor who did not know the newest therapy for a disorder but did know how to recognize the disorder itself. Knowledge of practice standards is not wisdom. If our strength as physicians were the ability to recite the latest practice standards and drug names, sick patients would be right to avoid us. Finally, Choudhry and colleagues concluded that older physicians produce worse outcomes than younger ones. However, they failed to exclude articles that did not correct for patient age and disease severity. Had they done so, they would have had virtually nothing to review. Older doctors usually have older and sicker patients. If this is not taken into account, interpretation of all such studies is flawed from the beginning. Even in the era of evidencebased medicine, the mortality rate remains 1 per person. Do the authors really believe that if we all had younger doctors, the mortality rate would fall? The crux of the issue is the value of experience and the methods by which one obtains it. No one argues for the repetition of mistakes masquerading as experience. But age brings 2 things: graciousness and time to realize that fads in treatment and medical reform come and go. Any physician, young or old, who fails to carefully observe

Academic Medicine, 2007

* This list enumerates a number of factors that have recently stimulated discussions concerning e... more * This list enumerates a number of factors that have recently stimulated discussions concerning educational redesign in internal medicine. Several factors are repeated from earlier episodes of redesign activity while others are new to this period. The recommendations of the Alliance for Academic Internal Medicine Education Redesign Task Force take into consideration these and other factors. * This list provides the major recommendations of the AAIM Education Redesign Task Force. These recommendations were approved by all of the alliance organizations in April and May 2007. The authors encourage readers to consider the total effect of the recommendations rather than the effect of individual recommendations.

Academic Medicine, 2007

To assess the psychometric properties of the three components of the Diabetes Practice Improvemen... more To assess the psychometric properties of the three components of the Diabetes Practice Improvement Module, to compare reliabilities of composites to individual measures, and to identify associations among practice-based and patient-based measures. Data include practice systems surveys of 626 physicians, 13,965 chart audits, and 12,927 patient surveys. Quality composites were identified using factor analysis. Means with reliabilities (intraclass correlation coefficient [ICC] and Cronbach's alpha) are reported. Associations among patient-based quality measures and practice measures with case-mix adjustments were estimated via hierarchical models. Composite ICCs range from 0.11 to 0.54, and single items range from 0.05 to 0.49. Staff communication, efficiency, care access, and patient knowledge correlate with patient satisfaction (P < .001). Clinical outcomes are associated with clinical processes (e.g., annual foot exam) and appropriate treatment (P < .001). Patient adjusters (e.g., overall health or factors limiting self-care) are important for the models; physician characteristics used (e.g., age, practice size) seem less important. Composites require smaller patient sample sizes and result in more reliable measures than do individual items. Additionally, the data show meaningful relationships between composites; physician-directed components (i.e., clinical processes and treatments) are related to clinical outcomes, and patients are clearly more satisfied with care if it is easily accessible and if communication about care is good.

Academic Medicine, 2004

Accreditation of residency programs and certification of physicians requires assessment of compet... more Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Academic Medicine, 1996

No abstract available.

T he structure, process, and outcomes of internal medicine residency training have concerned the ... more T he structure, process, and outcomes of internal medicine residency training have concerned the profession for over 20 years. Over the last decade the initiative to move to outcomes-based education redefined the competencies physicians should obtain during training. The core principle of outcomes-based education is the objective demonstration that a graduating trainee, whether from medical school or a residency, possesses the knowledge, skills, and attitudes necessary to progress to the next stage of his or her professional career. The Accreditation Council for Graduate Medical Education (ACGME) and the Institute of Medicine (IOM) have defined core competencies for physicians shown in Table 1. While both the ACGME and IOM provide a framework for the desired outcomes, medical educators bear the burden of designing the structures and processes to achieve them. Educators face several key challenges in redesigning residency programs. First, residency programs must prepare trainees for ...

Journal of graduate medical education, 2013

Future physicians may not be prepared for the challenges of caring for the growing population of ... more Future physicians may not be prepared for the challenges of caring for the growing population of poor patients in this country. Given the potential for a socioeconomic "gulf" between physicians and patients and the lack of curricula that address the specific needs of poor patients, resident knowledge about caring for this underserved population is low. We created a 2-day Resident Academy orientation, before the start of residency training, to improve community knowledge and address resident attitudes toward poor patients through team-based experiential activities. We collected demographic and satisfaction data through anonymous presurvey and postsurvey t tests, and descriptive analysis of the quantitative data were conducted. Qualitative comments from open-ended questions were reviewed, coded, and divided into themes. We also offer information on the cost and replicability of the Academy. Residents rated most components of the Academy as "very good" or "exce...

Journal of graduate medical education, 2009

The Physician and Sportsmedicine, 2000

Despite the demands of a busy office setting, a brief physician counseling session about exercise... more Despite the demands of a busy office setting, a brief physician counseling session about exercise can be highly effective and well worth the precious time. Components include delivering a clear message about exercise, stepping back to assess the patient's readiness to change, and using the patient's cues to set an activity agenda. Physician counseling about exercise is crucial to improving patients' health status and to the success of the several activity recommendations contained in the federal government's Healthy People 2010 report.

Perspectives in Biology and Medicine, 2007

Few question the need for continuous professional development throughout a physician's career, bu... more Few question the need for continuous professional development throughout a physician's career, but rapid changes in health care are creating demand for physicians to acquire new knowledge, skills, and attitudes to implement quality improvement in clinical practice.The Internet and World Wide Web are technologies that have the potential to facilitate deep change in physician practice and lifelong learning. This paper describes how the American Board of Internal Medicine (ABIM) has utilized the Web and the Internet to engage physicians in the competencies of practicebased learning and improvement and systems-based practice. Specifically, we describe how the ABIM developed and implemented Web-based practice improvement modules (PIMs) to help physicians measure and improve their clinical practice.

Journal of General Internal Medicine, 2006

The Institute of Medicine's first simple rule for quality health care is a long-term healing rela... more The Institute of Medicine's first simple rule for quality health care is a long-term healing relationship; and the first aim for a quality health care system is patient-centered care. 1 The Association of American Medical Colleges' Medical School Objective Project urged faculties to teach interpersonal and communication skills. 2 The Accreditation Council for Graduate Medical Education accredits residency programs based, in part, on their demonstration of residents' competence in interpersonal and communication skills. 3 Similarly, the American Board of Medical Specialties' member boards include communication skills in the criteria for certification and recertification. 4 Yet the scientific and theoretical basis for these recommendations remains sparse. The proceedings of the conference, ReForming Relationships in Health Care: Creating a National Research Agenda for Relationship-Centered Care, published in this supplement contributes to rectifying this deficiency. The plenary papers explain how, why, and what makes healing relationships succeed and fail. The conference outlines an ambitions agenda of research questions about the centerpiece of all health carethe healing relationship. The answers to these questions promise to inform healers, teachers of healers, evaluators of the quality of healing, and social institutions that support healing. The philosophy of medical care called relationship-centered care (RCC) provides the ideological glue that holds these papers together. 5 On superficial inspection RCC appears to be a synonym for its antecedent, and possibly more familiar patient-centered care or the humanistic qualities of Care. Such short shrift would be unfortunate, for RCC plows new ground by expanding the concept of the physician patient relationship to one that includes the personhood of both the patient and the physician, acknowledges the central role played by the emotions of both parties in the relationship and the fact that the relationship is shaped by reciprocal influence rather than only by humanistic, but still largely unidirectional, therapeutic ministrations. Were the RCC philosophy to stop with expanding the ideas about the physician patient relationship, it still would be a substantial advance; however, its authors go further. They promote the idea that health care emerges from the relationships between all of the people who make up the institutions and communities responsible for health care. In all of these relationships, the personhood, emotions, and reciprocal influences of everyone on everyone else actively shape the quality of care, the experience of health and illness, and satisfaction of everyone involved. 6 At first blush, RCC appears to challenge the basic tenants of traditional medical professionalism. It displaces the old idea that physicians be compassionate yet somewhat depersonal

Journal of General Internal Medicine, 2008

Journal of General Internal Medicine, 2005

Journal of Continuing Education in the Health Professions, 2006

Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and re... more Introduction: The American Board of Internal Medicine (ABIM) recognized that certification and recertification must be based on an assessment of performance in practice as well as an examination of medical knowledge. Physician self-assessment of practice performance is proposed as one method that certification boards may use to evaluate competence in practice-based learning and improvement and systems-based practice. Methods: Sixteen practicing general internists and endocrinologists with 10-year time-limited certification participated in a beta test of the ABIM's diabetes practice improvement module (PIM) as part of their recertification program. A PIM consists of a self-directed medical record audit, practice system survey, and patient survey. A quality improvement education specialist from the Connecticut Quality Improvement Organization provided on-site and distance consultation on quality improvement methods and tools. An independent audit assessed the reliability of physician self-audit. Qualitative interviews were conducted at 2 time points to assess for physician satisfaction and behavioral change in quality improvement. Results: Fourteen physicians completed the diabetes PIM. All but 1 physician found the medical record audit to provide important information about the practice. Of the 11 physicians who completed a follow-up interview, 10 stated that the quality improvement education specialist helped improve their practice. Discussion: Self-assessment using the ABIM diabetes PIM as part of recertification provides valuable practice information and can lead to meaningful behavioral change by physicians. Collaboration with an educator in quality improvement appears to facilitate the effects of the practice improvement module. Future work should investigate the effect on patient outcomes.

Journal of Continuing Education in the Health Professions, 2008

Background: Quality measurement and improvement in practice are requirements for Maintenance of C... more Background: Quality measurement and improvement in practice are requirements for Maintenance of Certification by the American Board of Medical Specialties boards and a component of many pay for performance programs.

JAMA, 2006

Blueprint for establishing effective postbaccalaureate medical school pre-entry program for educa... more Blueprint for establishing effective postbaccalaureate medical school pre-entry program for educationally disadvantaged students.

Annals of Internal Medicine, 2004

Annals of Internal Medicine, 2005

Choudhry and colleagues' paper may be technically flawed, but more important, in our view it is p... more Choudhry and colleagues' paper may be technically flawed, but more important, in our view it is potentially destructive (1). Behind the mask of "evidence-based medicine," the authors reviewed 59 articles, selected by their own peculiar process from hundreds of potential papers relevant to the subject. They then analyzed this sample according to 4 criteria: knowledge; adherence to standards of practice for diagnosis, screening, and prevention; adherence to standards of appropriate therapy; and outcomes. They concluded that physicians who have been practicing longer may be at risk for providing lower-quality care and may need quality improvement interventions. This "systematic review" was not in the least systematic. Of 245 articles retrieved by an Internet search engine, the authors excluded 167 for various arbitrary reasons and excluded 3 others for reasons that were not characterized. To the 78 papers that remained, the authors added 9 articles from their personal archives and 35 more from a reference list search. Of the 122 papers discovered by this circuitous route, the authors excluded 63 more because the practice variation or outcomes were not clearly related to quality of care or because the relationship between length of time in practice or physician age and outcomes was not reported. Four additional papers were excluded for other reasons. This extraordinary process yielded the 59 articles that were the subject of the paper. All 4 of the authors' criteria indicate the core weakness of measuring quality in an evidence-based manner. The first criterion, knowledge, would be more accurately described as "information." If patients desired and sought only information, they could consult the Internet rather than a physician. The next 2 criteria, adherence to standards of practice for diagnosis, screening, and prevention and adherence to standards of practice for therapy, are also superficial gauges of quality medicine. Patients do not seek consultation for a more fastidious application of standards; they look to us for a wise, compassionate analysis of their problem. Certainly, a patient would be in better hands with a doctor who did not know the newest therapy for a disorder but did know how to recognize the disorder itself. Knowledge of practice standards is not wisdom. If our strength as physicians were the ability to recite the latest practice standards and drug names, sick patients would be right to avoid us. Finally, Choudhry and colleagues concluded that older physicians produce worse outcomes than younger ones. However, they failed to exclude articles that did not correct for patient age and disease severity. Had they done so, they would have had virtually nothing to review. Older doctors usually have older and sicker patients. If this is not taken into account, interpretation of all such studies is flawed from the beginning. Even in the era of evidencebased medicine, the mortality rate remains 1 per person. Do the authors really believe that if we all had younger doctors, the mortality rate would fall? The crux of the issue is the value of experience and the methods by which one obtains it. No one argues for the repetition of mistakes masquerading as experience. But age brings 2 things: graciousness and time to realize that fads in treatment and medical reform come and go. Any physician, young or old, who fails to carefully observe

Academic Medicine, 2007

* This list enumerates a number of factors that have recently stimulated discussions concerning e... more * This list enumerates a number of factors that have recently stimulated discussions concerning educational redesign in internal medicine. Several factors are repeated from earlier episodes of redesign activity while others are new to this period. The recommendations of the Alliance for Academic Internal Medicine Education Redesign Task Force take into consideration these and other factors. * This list provides the major recommendations of the AAIM Education Redesign Task Force. These recommendations were approved by all of the alliance organizations in April and May 2007. The authors encourage readers to consider the total effect of the recommendations rather than the effect of individual recommendations.

Academic Medicine, 2007

To assess the psychometric properties of the three components of the Diabetes Practice Improvemen... more To assess the psychometric properties of the three components of the Diabetes Practice Improvement Module, to compare reliabilities of composites to individual measures, and to identify associations among practice-based and patient-based measures. Data include practice systems surveys of 626 physicians, 13,965 chart audits, and 12,927 patient surveys. Quality composites were identified using factor analysis. Means with reliabilities (intraclass correlation coefficient [ICC] and Cronbach's alpha) are reported. Associations among patient-based quality measures and practice measures with case-mix adjustments were estimated via hierarchical models. Composite ICCs range from 0.11 to 0.54, and single items range from 0.05 to 0.49. Staff communication, efficiency, care access, and patient knowledge correlate with patient satisfaction (P < .001). Clinical outcomes are associated with clinical processes (e.g., annual foot exam) and appropriate treatment (P < .001). Patient adjusters (e.g., overall health or factors limiting self-care) are important for the models; physician characteristics used (e.g., age, practice size) seem less important. Composites require smaller patient sample sizes and result in more reliable measures than do individual items. Additionally, the data show meaningful relationships between composites; physician-directed components (i.e., clinical processes and treatments) are related to clinical outcomes, and patients are clearly more satisfied with care if it is easily accessible and if communication about care is good.

Academic Medicine, 2004

Accreditation of residency programs and certification of physicians requires assessment of compet... more Accreditation of residency programs and certification of physicians requires assessment of competence in communication and interpersonal skills. Residency and continuing medical education program directors seek ways to teach and evaluate these competencies. This report summarizes the methods and tools used by educators, evaluators, and researchers in the field of physician-patient communication as determined by the participants in the "Kalamazoo II" conference held in April 2002. Communication and interpersonal skills form an integrated competence with two distinct parts. Communication skills are the performance of specific tasks and behaviors such as obtaining a medical history, explaining a diagnosis and prognosis, giving therapeutic instructions, and counseling. Interpersonal skills are inherently relational and process oriented; they are the effect communication has on another person such as relieving anxiety or establishing a trusting relationship. This report reviews three methods for assessment of communication and interpersonal skills: (1) checklists of observed behaviors during interactions with real or simulated patients; (2) surveys of patients' experience in clinical interactions; and (3) examinations using oral, essay, or multiple-choice response questions. These methods are incorporated into educational programs to assess learning needs, create learning opportunities, or guide feedback for learning. The same assessment tools, when administered in a standardized way, rated by an evaluator other than the teacher, and using a predetermined passing score, become a summative evaluation. The report summarizes the experience of using these methods in a variety of educational and evaluation programs and presents an extensive bibliography of literature on the topic. Professional conversation between patients and doctors shapes diagnosis, initiates therapy, and establishes a caring relationship. The degree to which these activities are successful depends, in large part, on the communication and interpersonal skills of the physician. This report focuses on how the physician's competence in professional conversation with patients might be measured. Valid, reliable, and practical measures can guide professional formation, determine readiness for independent practice, and deepen understanding of the communication itself.

Academic Medicine, 1996

No abstract available.