Medical Education Patient-centered interviewing and student performance in a comprehensive clinical skills examination: Is there an association? Emran Rouf a, *, Heidi Chumley b , Alison Dobbie c a Section of General Internal Medicine, Geriatric and Hospital Medicine, University of Missouri – Kansas City School of Medicine, 2411 Holmes Street, Kansas City, MO 64108, USA b Department of Family Medicine, University of Kansas School of Medicine, Kansas City, KS 66160, USA c Department of Family Medicine, University of Texas Southwestern Medical Center, Dallas, TX 75390, USA 1. Introduction In many countries, including the United States, medical schools and regulatory agencies have increasingly called for the teaching of patient-centered communication skills [1,2]. Patient-centered communication skills have been associated with increased patient satisfaction [3,4], positive health outcomes [5,6], decreased litigation [7,8], and improved patient adherence [9,10]. In addition, some studies have demonstrated that patient-centered interview techniques can improve diagnostic accuracy [11–13]. Many medical schools use standardized patients (SP) to teach clinical skills, including professionalism [14,16,21,22] and medical inter- viewing [15–17], and multiple studies have demonstrated the reliability and validity of SP-based examinations [14,19–21]. Educators have developed validated communication assessment tools that can assess doctor–patient communication, including patient-centered interviewing [23–25]. In 2004, the National Board of Medical Examiners (NBME) introduced the USMLE Step 2 Clinical Skills (CS) examination to assess the clinical skills of graduating medical students by using SP-based clinical encounters. This additional licensing require- ment has prompted many medical schools to introduce a Patient Education and Counseling 75 (2009) 11–15 ARTICLE INFO Article history: Received 24 March 2008 Received in revised form 4 September 2008 Accepted 26 September 2008 Keywords: Patient-centered interviewing Interpersonal and communication skills Clinical skills assessment ABSTRACT Objective: Communication skills, including patient-centered interviewing (PCI), have become a major priority for educational and licensing organizations in the United States. While patient-centered interviewing is associated with positive patient outcomes and improved diagnostic accuracy, it is unknown if an association exists between patient-centered interviewing and student performance in high-stakes clinical skills assessment (CSA) examinations. The purpose of this study was to determine if generic communication skills and patient-centered interviewing skills were associated with students’ overall student performance on a multi-station clinical skills assessment (CSA) examination. Methods: This was a cross-sectional study to assess student performance with standardized patients (SPs). We conducted a retrospective review of 30 videotaped SP encounters of Third year medical students (class of 2006) at the University of Kansas School of Medicine. We measured correlations between observed PCI scores, overall CSA scores and CSA interpersonal and communication (ICS) skills scores of student–SP encounters. Results: PCI scores, as measured with the Four Habits Coding Scheme, a measurement tool of patient- centered communication, were not correlated with either overall CSA scores or ICS scores. Students’ PCI scores were lower than the ICS scores (57% vs. 85% of correct items). The students performed poorly (30% mean score of correct items) in eliciting patient perspectives, compared to three other domains (Invest in the beginning, Demonstrate empathy, and Invest in end) of patient-centered interviewing. Conclusions: Our study failed to demonstrate any association between student performance and patient- centered interviewing skills (PCI) in the setting of a comprehensive in-house CSA examination. Third-year medical students in our study did not practice some elements of patient-centered interviewing. Practice implications: Given the increasing importance of patient-centered communication, the high- stakes in-house clinical skills examinations may consider assessing patient-centered interviewing using a more comprehensive and valid checklist. ß 2008 Elsevier Ireland Ltd. All rights reserved. * Corresponding author. Tel.: +1 816 235 6169; fax: +1 816 235 5538. E-mail address: roufe@umkc.edu (E. Rouf). Contents lists available at ScienceDirect Patient Education and Counseling journal homepage: www.elsevier.com/locate/pateducou 0738-3991/$ – see front matter ß 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.pec.2008.09.016