title: Context factors in consultations of general practitioner trainees and their impact on communication assessment in the authentic setting.
abstract: OBJECTIVE
  Acquiring adequate communication skills is an essential part of general practice (GP) specialty training. In assessing trainee proficiency, the context in which trainees communicate is usually not taken into account. The present paper aims to explore what context factors can be found in regular GP trainee consultations and how these influence their communication performance.
  
  
  METHODS
  In a randomly selected sample of 44 videotaped, real-life GP trainee consultations, we searched for context factors previously identified in GP consultations and explored how trainee ratings change if context factors are taken into account. Trainee performance was rated twice using the MAAS-Global, first without and then with incorporating context factors. Item score differences were calculated using a paired samples t-test and effect sizes were computed.
  
  
  RESULTS
  All previously identified context factors were again observed in GP trainee consultations. In communication assessment scores, we found a significant difference in 5 out of 13 MAAS-Global items, mostly in a positive direction. The effect size was moderate (0.57).
  
  
  CONCLUSIONS
  GP trainee communication is influenced by contextual factors; they seem to adapt to context in a professional way.
  
  
  CONCLUSIONS
  GP specialty training needs to focus on a context-specific application of communication skills. Communication raters need to be taught how to incorporate context factors into their assessments.
authors.affiliation: Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands. Electronic address: G.Essers@elg.umcn.nl.
authors.forename: Geurt
authors.initials: G
authors.lastname: Essers
authors.forename: Sandra
authors.initials: S
authors.lastname: van Dulmen
authors.forename: Judy
authors.initials: J
authors.lastname: van Es
authors.forename: Chris
authors.initials: C
authors.lastname: van Weel
authors.forename: Cees
authors.initials: C
authors.lastname: van der Vleuten
authors.forename: Anneke
authors.initials: A
authors.lastname: Kramer
mesh_terms: D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D005194:Family Practice / Q000193:education*; D058006:General Practice; D058005:General Practitioners / Q000193:education*; D006801:Humans; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D014743:Videotape Recording
keywords: Communication in context; General practice; Medical education; Postgraduate education; Primary health care