Longitudinal Effects of Medical Students' Communication Skills on Future Performance

Background: The Essential Elements of Communication (EEC) were developed from the Kalamazoo consensus statement on physician-patient communication. The Uniformed Services University of the Health Sciences (USU) has adopted a longitudinal curriculum to use the EEC both as a learning tool during standardized patient encounters and as an evaluation tool culminating with the end of preclerkship objective-structured clinical examinations (OSCE). Medical educators have recently emphasized the importance of teaching communication skills, as evidenced by the United States Medical Licensing Examination testing both the integrated clinical encounter (ICE) and communication and interpersonal skills (CIS) within the Step 2 Clinical Skills exam (CS). Purpose: To determine the associations between students' EEC OSCE performance at the end of the preclerkship period with later communication skills assessment and evaluation outcomes in the context of a longitudinal curriculum spanning both undergraduate medical education and graduate medical education. Methods: Retrospective data from preclerkship (overall OSCE scores and EEC OSCE scores) and clerkship outcomes (internal medicine [IM] clinical points and average clerkship National Board of Medical Examiners [NBME] scores) were collected from 167 USU medical students from the class of 2011 and compared to individual scores on the CIS and ICE components of Step 2 CS, as well as to the communication skills component of the program directors' evaluation of trainees during their postgraduate year 1 (PGY-1) residency. In addition to bivariate Pearson correlation analysis, we conducted multiple linear regression analysis to examine the predictive power of the EEC score beyond the IM clerkship clinical points and the average NBME Subject Exams score on the outcome measures. Results: The EEC score was a significant predictor of the CIS score and the PGY-1 communication skills score. Beyond the average NBME Subject Exams score and the IM clerkship clinical points, the EEC score explained an additional 13% of the variance in the Step 2 CIS score and an additional 6% of the variance in the PGY-1 communication skills score. In addition, the EEC score was more closely associated with the CIS score than the ICE score. Conclusion: The use of a standardized approach with a communication tool like the EEC can help explain future performance in communication skills independent of other education outcomes. In the context of a longitudinal curriculum, this information may better inform medical educators on learners' communication capabilities and more accurately direct future remediation efforts.