Reassessing doctor-patient communication to reflect a context-based communication competency perspective: the behavior change and error disclosure interview

While physicians medical interviewing skills are developed in medical school, prior research finds training and assessment of these skills are often misaligned. The goal of the thesis was to provide a context-based format to identify competent context-based communication behaviors and modify existing assessment so that the teaching and assessment are consistent. Two contexts, the behavior change interview (BCI) and error disclosure (ErD) were examined. Tapes of medical students interacting with standardized patients in BCI and ErD contexts and assessments made by their instructors were examined. Extant BCI assessments focus on medical immediacy whereas the revised assessment includes immediacy (validation, active listening, and friendliness) and inhibitory behaviors (surprise, judging, premature change talk and blaming). Extant ErD assessments were revised to explicitly assess verbal behavior (e.g., stating the error, apology, and rectification). These two assessments offer guidance towards a context-based approach to teaching and evaluating communication skills.