Inconsistency of residents' communication performance in challenging consultations.
OBJECTIVE
Communication performance inconsistency between consultations is usually regarded as a measurement error that jeopardizes the reliability of assessments. However, inconsistency is an important phenomenon, since it indicates that physicians' communication may be below standard in some consultations.


METHODS
Fifty residents performed two challenging consultations. Residents' communication competency was assessed with the CELI instrument. Residents' background in communication skills training (CST) was also established. We used multilevel analysis to explore communication performance inconsistency between the two consultations. We also established the relationships between inconsistency and average performance quality, the type of consultation, and CST background.


RESULTS
Inconsistency accounted for 45.5% of variance in residents' communication performance. Inconsistency was dependent on the type of consultation. The effect of CST background training on performance quality was case specific. Inconsistency and average performance quality were related for those consultation combinations dissimilar in goals, structure, and required skills. CST background had no effect on inconsistency.


CONCLUSIONS
Physician communication performance should be of high quality, but also consistent regardless of the type and complexity of the consultation.


CONCLUSIONS
In order to improve performance quality and reduce performance inconsistency, communication education should offer ample opportunities to practice a wide variety of challenging consultations.
University of Groningen, University Medical Center Groningen, The Netherlands. Electronic address: j.c.wouda@umcg.nl.
Jan C
JC
Wouda
Harry B M
HB
van de Wiel
D002983:Clinical Competence; D003142:Communication; D004521:Educational Measurement; D006801:Humans; D007396:Internship and Residency; D016544:Patient Simulation; D010817:Physician-Patient Relations; D012017:Referral and Consultation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D014743:Videotape Recording
Challenging consultations; Communication performance inconsistency; Residents