Validation of the doctor±patient communication component of the Educational Commission for Foreign Medical Graduates Clinical Skills Assessment Gerald P Whelan, 1 Danette W McKinley, 1 John R Boulet, 1 Jeanne Macrae 2 & Stephan Kamholz 2 Background The pivotal role of doctor±patient com- munication in effective health care delivery led the Educational Commission for Foreign Medical Gradu- ates (ECFMG) to incorporate the assessment of inter- personal skills and spoken English pro®ciency into its Clinical Skills Assessment (CSA). Furthermore, it was decided that to pass the CSA, a candidate would need to meet or surpass de®ned performance standards for doctor±patient communication as a discrete compo- nent. This requirement, among others, is designed to ensure the readiness of graduates of foreign medical schools (FMGs) to enter postgraduate medical educa- tion programmes in the United States. Objective The primary focus of this study was to determine the extent to which performance in a simu- lated testing environment is related to performance in the clinical setting. Method Nurses were trained to rate the communication skills of residents from the patient's perspective. A total of 43 ®rst-year residents were evaluated. The survey ratings (n  225) were compared with the residents' CSA communication scores. Results Corrected correlations between CSA ratings and those obtained from nurses ranged from 0á61 to 0á73. Conclusion This study provides evidence for the validity of the communication ratings provided by standardized patients. The reasonably strong associations between ratings obtained during testing and those obtained through observation of `real' patient interactions sug- gest that external observers can provide accurate eval- uations of doctor±patient communication. Keywords Clinical competence; *communication; delivery of health care; education, medical, *methods; *physician±patient relations; validation study. Medical Education 2001;35:757±761 Introduction The Educational Commission for Foreign Medical Graduates (ECFMG) has developed a performance- based assessment to evaluate the clinical skills of graduates of foreign medical schools (FMGs) who wish to enter postgraduate medical education programmes in the United States. To receive ECFMG certi®cation, candidates must have their medical school diplomas validated, pass the United States Medical Licensure Examination (USMLE) Steps 1 and 2, pass the Test of English as a Foreign Language (TOEFL), and pass the Clinical Skills Assessment (CSA). Pro®ciency in several domains, including data gathering (history taking and physical examination), written communication with the health care team (composing a patient note), interper- sonal skills, and spoken English are all assessed through CSA. The ability of a physician to interact with a patient is an important part of medical practice. 1 Effective com- munication has been shown to increase patient satis- faction, compliance, and the likelihood of seeking care in an appropriate time frame. 2 In addition, patient outcomes (e.g. recovery rates) tend to be better for patients whose care is managed by physicians with good interpersonal skills. 3 The pivotal role of doctor±patient communication in effective health care delivery led the ECFMG to incorporate the assessment of interpersonal skills and spoken English pro®ciency into the CSA. 1 Educational Commission for Foreign Medical Graduates, Philadel- phia, Pennsylvania, USA 2 State University of New York Downstate Medical Center, Kings County Hospital Center, New York State, USA Correspondence: G P Whelan, Educational Commission for Foreign Medical Graduates, 3624 Market Street, Philadelphia, PA 19104 USA Language skills Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:757±761 757