title: Context factors in general practitioner-patient encounters and their impact on assessing communication skills--an exploratory study.
abstract: BACKGROUND
  Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor's proficiency.Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.
  
  
  METHODS
  We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.
  
  
  RESULTS
  In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p<0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.
  
  
  CONCLUSIONS
  Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent 'adequate GP communication behaviour'. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as 'signal' instead of 'noise' in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.
authors.affiliation: Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. g.essers@elg.umcn.nl
authors.forename: Geurt
authors.initials: G
authors.lastname: Essers
authors.forename: Anneke
authors.initials: A
authors.lastname: Kramer
authors.forename: Boukje
authors.initials: B
authors.lastname: Andriesse
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D005163:Factor Analysis, Statistical; D005260:Female; D058006:General Practice / Q000592:standards; D058005:General Practitioners / Q000193:education / Q000523:psychology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011364:Professional Practice / Q000592:standards*; D036301:Qualitative Research; D012017:Referral and Consultation / Q000592:standards; D015203:Reproducibility of Results