title: A discourse analysis study of 'good' and 'poor' communication in an OSCE: a proposed new framework for teaching students.
abstract: BACKGROUND
  There is still a great deal to be learnt about teaching and assessing undergraduate communication skills, particularly as formal teaching in this area expands. One approach is to use the summative assessments of these skills in formative ways. Discourse analysis of data collected from final year examinations sheds light on the grounds for assessing students as 'good' or 'poor' communicators. This approach can feed into the teaching/learning of communication skills in the undergraduate curriculum.
  
  
  METHODS
  A final year UK medical school objective structured clinical examination (OSCE).
  
  
  METHODS
  Four scenarios, designed to assess communication skills in challenging contexts, were included in the OSCE. Video recordings of all interactions at these stations were screened. A sample covering a range of good, average and poor performances were transcribed and analysed. Discourse analysis methods were used to identify 'key components of communicative style'.
  
  
  RESULTS
  Analysis revealed important differences in communicative styles between candidates who scored highly and those who did poorly. These related to: empathetic versus 'retractive' styles of communicating; the importance of thematically staging a consultation, and the impact of values and assumptions on the outcome of a consultation.
  
  
  CONCLUSIONS
  Detailed discourse analysis sheds light on patterns of communicative style and provides an analytic language for students to raise awareness of their own communication. This challenges standard approaches to teaching communication and shows the value of using summative assessments in formative ways.
authors.affiliation: Department of Education and Professional Studies, King's College London, UK. celiaroberts@lineone.net
authors.forename: Celia
authors.initials: C
authors.lastname: Roberts
authors.forename: Val
authors.initials: V
authors.lastname: Wass
authors.forename: Roger
authors.initials: R
authors.lastname: Jones
authors.forename: Srikant
authors.initials: S
authors.lastname: Sarangi
authors.forename: Annie
authors.initials: A
authors.lastname: Gillett
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003479:Curriculum; D004504:Education, Medical, Undergraduate / Q000592:standards*; D004521:Educational Measurement / Q000379:methods; D004739:England; D006801:Humans