THE ASSESSMENT OF COMMUNICATION-SKILLS IN PALLIATIVE MEDICINE - A COMPARISON OF THE SCORES OF EXAMINERS AND SIMULATED PATIENTS

The Diploma in Palliative Medicine was established in 1991. and includ ed communication skills as a major part of the curriculum. In order to assess the efficacy of doctors' communication skills in the Diploma e xamination, an assessment tool was developed based on the modified Pre vara Score. Simulated (actor) patients are used for the consultation i n the examination; the doctors' performance is assessed independently by the examiner and by the actor. This provides an opportunity to cons ider the methods used for describing agreement between raters. There w as high correlation between examiners' and actors' scores and high acc eptability of the scoring method. However, satisfactory agreement in t erms of the mean differences between scores and their standard deviati on between examiners' and actors' scores was not achieved. We have fou nd the simulated patient interview to be a useful teaching and assessm ent tool. The good correlation between the observer's (examiner) and t he recipient's (actor-patient) perception of the doctor's interviewing skills provides evidence of the validity of the assessment. However t he actor-patients' ratings tended to be higher and the two groups of a ssessors could not be used interchangeably. We conclude that actor-pat ients are of value in teaching and in assessing the communication skil ls of doctors but produce different scores to clinical examiners.