Funded mini-projects
(443) Development of an interactive video library of case studies for the teaching and assessment of communication skills of medical undergraduate students
N.B. The information below is authored by the mini-project applicants, not by staff of the subject centre.
This text represents the views and opinions of the mini-project team
only, not those of the subject centre or its affiliates.
Principal investigator
Anita Laidlaw, University of St. Andrews
Full list of project partners
Dr Anita Laidlaw,
Prof Gerry Humphris
Topic
This is a JISC eLEARNING CASE STUDY proposal; promote collaboration to enhance new and existing partnerships, pump prime feasibility studies in innovative areas.
Background
Communication skills are now recognised by the GMC as a key component of a medical students’ undergraduate training (GMC, Tomorrows Doctors). The teaching and assessment of these skills are an important component of medical curricula in the UK. Currently the majority of medical schools use practical exams such as the Objective Structured Clinical Exam (OSCE) to assess communication skills. OSCEs are important and helpful assessments but are time consuming and labour intensive. They test specifically the students practical abilities without tapping their understanding and what may be termed their cognitions associated with these behaviours. Some medical schools attempt to assess communication skills understanding by use of written examinations but these tend to be limited by testing broad theoretical knowledge. One method, called The Objective Structured Video Exams (OSVE) was developed in Liverpool by Humphris and Kaney (2000)1 as a pencil and paper test which is flexible, in terms of the knowledge / cognitive approaches that can be assessed, but it is also organisationally challenging and quite inflexible for the student.
We are working with the University of Amsterdam medical school, to develop a computerised version of the OSVE. This software has the capability of being used in a variety of different applications for the teaching and assessment of communication skills, including formative and summative assessment as well as providing a library of case studies that students could test their knowledge in their own time.
The software for the computerised OSVE (ACT software) was developed by Rob Hulsman from the University of Amsterdam Medical School (AMC). ACT shows the student a series of video clips of doctor-patient interactions including in an adjoining panel, the transcript for that interaction. On the same screen questions are presented to which the student can type in their answers2.
This has progressed the traditional OSVE in several ways:
• ACT is interactive, allowing the students to replay parts of the video clip by clicking on the desired section in the transcript.
• The student can specifically state which parts of the interaction they are referring to in their answer as each spoken turn in the interaction has an identifying number.
• Students can also progress at their own pace. The original OSVE demanded students to adhere to a strict timetable of video presentation and answering.
• Answers are stored in an electronic text file for printing and marking. Therefore handwriting does not have to be read.
• Answers for all questions are stored centrally in a dedicated database allowing subsequent analysis to be conducted on numerous occasions in the future.
• In addition the database stores all questions and electronically links them to the video clips and transcripts. The software enables modified sets of questions to be set for the video scenarios to devise new exams. Hence the difficulty level and emphasis of the question can be changed easily.
This proposal aims to produce a library of video case studies for use with ACT. This would allow us to develop a greater range of situations for the students to be tested on. Context has been shown to be important to student performance in OSVEs3 . The production of more case studies will enable us to provide a library of video clips for student self study.
To produce a bank of case studies requires considerable time and expertise in developing scripts, training of simulated patients, filming scenarios and linking the transcripts to the video clips for use within the ACT software.
1Humphris.G, Kaney.S; The objective structures video exam for assessment of communication skills; Medical Education; 2000; 34; 939 – 945
2 Hulsman.RL, Mollema.ED, Hoos.AM, de Haes.JCJM, Donnison-Speijer.JD; Assessment of medical communication skills by computer: assessment method and student experiences; Medical Education; 2004; 38; 813 - 824
3 Hulsman.RL, Mollema.ED, Oort.FJ, Hoos.AM, de Haes.JCJM; Using standardized video cases for assessement of medical communication skills. Reliability of objective structured video examinations by computer; Patient Education and Counseling; 2006; 60; 24 – 31
Proposed activities
To produce a library of case studies requires several steps:
• Development of scripts for doctor-patient interactions incorporating a variety of contexts (history taking, giving information, breaking bad news) as well as challenges (angry patient, demanding patient, medically unexplained symptoms) and providing good scope for questions.
• Recruitment of actors to play the role of patients.
• Filming of the scenario which requires high quality audiovisual material.
• Transcription of the scenario from filmed material.
• Linking of the transcript to the film within the ACT software.
The production of 10 new video case studies is challenging however once several video clips have been produced, the ACT software can be utilised to produce a bank of questions relating to the clips which can then be easily assimilated into tests for both assessment and teaching.
Proposed outcomes
Although we currently provide training in small group sessions where students practice their communication skills, to all our medical undergraduates, it is also beneficial for them to be able to critically assess communication skills in others and to think about their approach to communication. The adoption of this software tool has the potential to develop students’ ability to (a) assess communication in a clinical context (b) develop their understanding about communication processes and, (c) encourage a more interpretive and analytical approach to doctor/patient communication. This can be achieved within a teaching environment with integrated assessment.
Increasing the number of case studies would give us greater variability of context within the cases, such as history taking, giving information, breaking bad news. There is evidence to suggest that the context of the doctor-patient interaction can impact on students performance3. This would also enable us to create parallel cases of different situations (for example two versions of breaking bad news) for flexibility of use during examinations and also to allow students to practice formatively. This software and video library has the potential to improve communication skills teaching and assessment for all of our undergraduate medical students.
Expertise of grant holder and project team
I am currently working on a project to develop the ACT software for use within the University of St Andrews Medical School for the formative assessment of undergraduate medical students. This project was funded by an internal Strategic Enhancement of Learning Fund grant which covered the cost of purchasing the software.
I am also interested in the methodology of teaching communication skills and have been involved in two projects aimed at investigating the use of ‘refection-on-action’ as a method for managing simulated patient-student role play in small group teaching. Both of these projects have received funding from a St Andrews University Fund for Initiatives in Learning, Teaching and Assessment. Some of this work was presented at the British Psychological Society, Social Psychology Section Conference, Edinburgh, 20054. I also received an award from the Subject Centre for Medicine, Dentistry and
Veterinary Medicine through its Rewarding Excellence in Learning and Teaching Competition 2006. This will allow me to travel to the Association of Medical Education in Europe conference in Genoa where I will present on some of my work relating to the use of ‘reflection-on-action’ in our communication skills teaching sessions.
Professor Humphris developed the original OSVE and is enthusiastic about the development of this methodology for teaching and assessment of communication skills1. We have established a strong link with AMC in the Netherlands. Dr Hulsman has made two visits to St Andrews to discuss and help with the installation of the software. Prof Humphris has recently returned from Amsterdam and seen a ‘live’ testing of the Dutch version of the ACT package with 150 students simultaneously in a single session.
4Von Wagner C, Laidlaw A, Humphris G ; Reflection-on-action: an experimental teaching initiative to facilitate simulated patient role play; In British Psychological Society, Social Psychology Section Conference; 2005; University of Edinburgh
Similar work
The ACT software was developed by Rob Hulsman, University of Amsterdam, where they currently use it for summative assessment with their medical students and also for selection of potential medical students. He has published two studies validating the ACT software and it’s use in the assessment of medical undergraduate communication skills2,3. We are collaborating with this group to develop the ACT software for use in the UK (currently all video clips are in the Dutch language).
This proposal therefore builds on current work to provide a useful tool for the assessment of communication skills in the UK based on one that is in use in Holland at the moment. It also goes further in trying to utilise the ACT software for teaching purposes in the development of an interactive library of case studies that students can access and use in their own time.
Contact details
Grant holder: Anita Laidlaw,
University of St. Andrews
Amount awarded: £1,000
Subject centre project contact: Suzanne Hardy
Reports
See the mid-term report for this project..
