title: Behavioral coding for evaluation of medical student communication: clarification or obfuscation?
abstract: OBJECTIVE
  To understand which specific student behaviors predict performance ratings from standardized patients and behavioral scientist preceptors.
  
  
  METHODS
  In 1996-98, objective, real-time ratings of student verbal and nonverbal behaviors were conducted on 75 videotaped interviews between second-year medical students and standardized patients at University of North Carolina at Chapel Hill School of Medicine. The coding system used in these analyses was developed based on evidence-based literature reviews and used software that provides for real-time recording; 30 nonverbal and 33 behaviors were coded. The coded behaviors were then compared with four ratings: a global rating of the encounter by the standardized patient, a summary score derived from a checklist completed by the standardized patient, a global rating of the encounter by a behavioral science preceptor who observed the encounter, and a summary score derived from a checklist completed by the preceptor.
  
  
  RESULTS
  Analyses identified strong correlations between all four of the preceptor and patient ratings, a strong independent effect of case scenario, and significant between-rater variation. When multivariable analysis was used to predict these global ratings based on coding of specific behaviors, a relatively high proportion of observer variation was explained by a small group of coded behaviors.
  
  
  CONCLUSIONS
  This study suggests that the coding of specific behaviors may hold promise as a student evaluation technique thereby improving medical training techniques and ultimately enhancing the communication skills in physician-patient encounters. It also illustrates the need to better clarify which specific behaviors are most critical in influencing patient satisfaction.
authors.affiliation: Department of Family Medicine, Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, North Carolina 27599-3376, USA. psloane@med.unc.edu
authors.forename: Philip D
authors.initials: PD
authors.lastname: Sloane
authors.forename: Rainer
authors.initials: R
authors.lastname: Beck
authors.forename: Vicki
authors.initials: V
authors.lastname: Kowlowitz
authors.forename: Angela M
authors.initials: AM
authors.lastname: Blotzer
authors.forename: Lily
authors.initials: L
authors.lastname: Wang
authors.forename: Luzmila
authors.initials: L
authors.lastname: Akins
authors.forename: Foy
authors.initials: F
authors.lastname: White-Chu
authors.forename: C Madeline
authors.initials: CM
authors.lastname: Mitchell
mesh_terms: D002983:Clinical Competence; D003625:Data Collection / Q000379:methods; D003627:Data Interpretation, Statistical; D006801:Humans; D007407:Interviews as Topic / Q000379:methods; D015999:Multivariate Analysis; D009633:Nonverbal Communication; D009657:North Carolina; D011369:Professional-Patient Relations; D013337:Students, Medical; D013647:Task Performance and Analysis; D014705:Verbal Behavior; D014741:Video Recording