Communication is one of the most important components of physicians' patient management skills and overall competence. Competence in a physician is a composite of clinical skills, interpersonal aspects of patient physician encounter, professionalism and communication skills [1
]. A good communicator can extract appropriate history from the patient, formulate an appropriate diagnosis, build a strong doctor patient relationship, and can appropriately negotiate management strategy with the patient.
OSCEs have been used extensively to assess communication skills. Measurement errors have been identified for case specificity, candidate-standardized patient (SP) interaction, and case-candidate interaction [4
]. Although Hodges, Turnbull, Cohen et al. reported a significant difference in the mean score of difficult and easy OSCE stations, they nevertheless concluded that communication skills are bound with content knowledge and are case or context specific [6
Guiton, Hodgson, Delandshere and Wilkerson found high internal consistency (Cronbach's alpha 0.89 – 0.94) within 7 OSCE stations [4
]. The Cronbach's alpha based on intra-item calculation across cases, however, was low. In their Generalizability analysis they found that the highest variance (50%) was contributed by students by case interaction implying that communication skills are case specific [4
]. Conversely, Keely, Myers and Dojeiji found that the internal consistency of one 22-minute station in an OSCE to test written communication skills of 36 Internal medicine residents from year 1 through 4, was 0.80. Moreover, they found that it correlated with a breaking bad news verbal communication station (r = 0.37 p
< 0.01) but not with the thyroid examination station (r = 0.04 ns) [7
OSCEs have been widely used to assess communication skills in students, residents, and other physicians for licensing and certification. The assessment of communication skills is still plagued with measurement errors related to content specificity, language proficiency, case and student interactions, variability in standardized patients, and assessment of written communication skills [8
]. Most studies have, however, found that even with reliable OSCE stations, the intra-item across case reliability is low [4
]. This low intra-item agreement (i.e., low reliability) across cases or stations indicates that communication skills are content specific.
Humphries used confirmatory factor analysis to identify the model best fitting the communication skills assessed through OSCE by SPs and expert examiners on objective structured video examination (OSVE) [9
]. He first identified the latent variables as specified by OSVE, SPs and the experts and then did confirmatory factor analysis to identify the best fitting model that could account for the effect of knowledge on future performance of candidates related to communication skills. He could not find a strong relationship between knowledge and performance of communications skills and concluded that better assessment tools need to be developed to assess this complex trait [9
In the OSCEs used for Clinical Skills Assessment of IMGs in the United States, SPs assess the candidates for communication, and data gathering skills (inclusive of history taking and physical examination), interpersonal skills and English proficiency [8
]. There is generally high test-retest reliability for all components and low correlations between English proficiency, interpersonal skills, and communication with measures of clinical competence [8
]. Conversely, Colliver and colleagues found high correlations between clinical competence and communication skills (also empathy) for specific cases [11
The foregoing and other studies have uncovered mixed evidence for generic and domain specific aspects of communication skills [4
]. Accordingly, further research is needed to investigate the issue of the domain specificity of assessment tools used for assessing communication skills in physicians. The purposes of the present study were to 1) study the psychometric characteristics of an instrument to assess communication used in high stakes OSCEs, and 2) investigate the specificity or generality of communication assessed in OSCEs vis à vis communication assessed in clinical practice.