title: Assessing communication quality of consultations in primary care: initial reliability of the Global Consultation Rating Scale, based on the Calgary-Cambridge Guide to the Medical Interview.
abstract: OBJECTIVE
  To investigate initial reliability of the Global Consultation Rating Scale (GCRS: an instrument to assess the effectiveness of communication across an entire doctor-patient consultation, based on the Calgary-Cambridge guide to the medical interview), in simulated patient consultations.
  
  
  METHODS
  Multiple ratings of simulated general practitioner (GP)-patient consultations by trained GP evaluators.
  
  
  METHODS
  UK primary care.
  
  
  METHODS
  21 GPs and six trained GP evaluators.
  
  
  METHODS
  GCRS score.
  
  
  METHODS
  6 GP raters used GCRS to rate randomly assigned video recordings of GP consultations with simulated patients. Each of the 42 consultations was rated separately by four raters. We considered whether a fixed difference between scores had the same meaning at all levels of performance. We then examined the reliability of GCRS using mixed linear regression models. We augmented our regression model to also examine whether there were systematic biases between the scores given by different raters and to look for possible order effects.
  
  
  RESULTS
  Assessing the communication quality of individual consultations, GCRS achieved a reliability of 0.73 (95% CI 0.44 to 0.79) for two raters, 0.80 (0.54 to 0.85) for three and 0.85 (0.61 to 0.88) for four. We found an average difference of 1.65 (on a 0-10 scale) in the scores given by the least and most generous raters: adjusting for this evaluator bias increased reliability to 0.78 (0.53 to 0.83) for two raters; 0.85 (0.63 to 0.88) for three and 0.88 (0.69 to 0.91) for four. There were considerable order effects, with later consultations (after 15-20 ratings) receiving, on average, scores more than one point higher on a 0-10 scale.
  
  
  CONCLUSIONS
  GCRS shows good reliability with three raters assessing each consultation. We are currently developing the scale further by assessing a large sample of real-world consultations.
authors.affiliation: Cambridge Centre for Health Services Research, University of Cambridge, Cambridge, UK.
authors.forename: Jenni
authors.initials: J
authors.lastname: Burt
authors.forename: Gary
authors.initials: G
authors.lastname: Abel
authors.forename: Natasha
authors.initials: N
authors.lastname: Elmore
authors.forename: John
authors.initials: J
authors.lastname: Campbell
authors.forename: Martin
authors.initials: M
authors.lastname: Roland
authors.forename: John
authors.initials: J
authors.lastname: Benson
authors.forename: Jonathan
authors.initials: J
authors.lastname: Silverman
mesh_terms: D002983:Clinical Competence; D003142:Communication; D058006:General Practice / Q000592:standards*; D058005:General Practitioners; D006801:Humans; D007407:Interviews as Topic; D016014:Linear Models; D015588:Observer Variation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011320:Primary Health Care / Q000592:standards*; D011787:Quality of Health Care; D012017:Referral and Consultation; D015203:Reproducibility of Results; D006113:United Kingdom; D014741:Video Recording
keywords: Medical Education & Training; Statistics & Research Methods