| INTRODUCTIONCommunication skill is one of 7 GMER domains.Since the implementation of The Regulation on the Handling of Medical Accidents in 2002,medical schools in china get to pay more attention to cultivate and assess communicative competence of their students.But most of these schools evaluate their students' communication skills by a survey using questionnaire of faculty or students' feedback,and little article in china reports using scale to assess medical students' communication skills.So this study employs the SEGUE Framework to assess Chinese medical students communication skills.The purpose of the study was to make sure the level of students' communication skills and its problem in China Medical University(CMU),and provide information to the teacher.The task of this study comes from the project 03-793,funded by China Medical Board(CMB).Subjects and MethodsSubjectIn 2007,we chose 400 medical students to evaluate their communication skills when they were interviewed with standard patient(SP)during the OSCE in CMU.MethodsAt first we searched and translated articles in communication.Then we decided to use the SEGUE Framework and its coding rules to evaluate medical students' communication skills.Two raters measured the students' communication skills by the Framework through observing students' interview with SP in set or in video.Reliability of measurementIntra-Rater reliability,Inter-Rater Agreement,Inter-rater reliability,general Consistency. Validity of measurementContent Validity,Constructive Validity,Criterion-Related Validity, Discrimination Validity.Statistical analysis.Data was input twice by two people and Comparing data entered twice by Epi-data 3.02.SPSS13.0 was employed to analyze the data,using Correlation analysis,ANOVA,MNOVA,U-test Chi-square test.Results400 cases of students' communication skills were measured and 28 cases were deleted for its validity.The validity rate is 93%.And 38 cases were measured in video, all of them were valid.1.The reliability and the validity of the SEGUE FrameworkInter-Rater Agreement,Intra-Rater reliability,Inter-Rater Agreement and Inter-rater reliability were 0.619,0.796,0.903 and 0.929 separately.And general Consistency in 3 SP stations was analyzed by kappa co-efficient ranged 0.66 to 0.92, and observation agreement ranged 0.84 to 0.96.Face Validity,Content Validity,Constructive Validity(Convergent Validity and Discrimination Validity),Criterion-Related Validity(Concurrent Validity and Predictive Validity),were testified by comparison of fifth-students and sixth-students in medical school(the communication skills score of sixth-students were higher than that of fifth-students),the correlation between the communication score and coders rating of the students(the Spearman correlation co-efficient was 0.75～0.58),the correlation between communication score and its latitudes(the Spearman correlation co-efficient with total score were 0.54～0.71,and between latitudes were 0.21～0.36),the correlation between communication score and OSCE score(the Spearman correlation co-efficient was 0.223)& its latitudes(the Spearman correlation co-efficient with total score were0.13～0.30).Differential Validity was computed by formula(D=0.42)and can be seen through the histogram whose curve distribution is like a normal curve.The results of these validities were fair.2.The level of communication skills for medical students in CMUOf 372 medical students,the SEGUE score ranged from 3 to 24,with a mean of 15.55(S.D.=3.65)and median of 16.However 37.4%students were identified as having trouble with communication skills during the assessment,accomplishing less than 60% of the task.The five latitudes score was 2.70,6.98,2.17,2.57 and 1.14 separately.3.Contrast with some American medical schools students' communication skillsAs understand 20 and understand 21 are not included in American medical schools' data,only 23 items was included to analyze.Comparison the American medical schools' data((?)=17.31,S.D=0.77,n=505)and the CMU data((?)=14.34, S.D=3.29,n=372)separately,and U-test is 15.8(p＜0.01).4.The relationship between competence of rapport building and communication skillsThe subjects were divided into two groups,and group 1 is the students whose Set the Stage 4(Make a personal connection during visit)score was 1,while group 2 was 0.The mean of group 1 was 15.48(S.D.=3.39,N=256),and group 1 was 13.50(S.D.=3.35,N=116).Comparing two groups by T-test(t=5.20,p＜0.01)Chi-square test showed that Set the Stage 4 had statistical significance with Set the Stage 5(Maintain pt's privacy),Elicit Information 14(Listen and,Give pt undivided attention),Give Information 18(Encourage pt to ask questions/check understanding) and all the items in Understand the Patient's Perspective.The relationship was identified by the Spearman Correlation Coefficient,which showed that Understand the Patient's Perspective 22 was highest(0.260),next was Elicit Information 14(0.223).DiscussionDiscussion1.The reliability and the validity of the SEGUE FrameworkThe result suggested that the reliability of the SEGUE Framework were high in this study.Besides,the inconsistent and effectiveness of the Framework are satisfying. So the Framework can be used to assess medical students' communication skills in China.2.Problems observed by raters during students having interview with SPConcluding the raters' Comments,we fond that most of students were willing to communicate with patients and more likely to be polite to the patient.However,too many students pay most attention to themselves rather than the patients,or pay most attention to patients' disease not patients' feeling and Perspective. 3.The communication skills of medical students in CMU was poorAs shown in table 7,communication skills of medical students was poor,with the latitudes of set the stage and give information need to pay more attention to.4.Students' communication skills in some American medical schools were much higher than that of in CMUAs shown in table 8,communication skills of the American students were 3 score more than that of students in CMU,the difference has statistical significance.It because most of medical schools in American having been paid more attention to communication skills' education and the America student has higher all-round quality.5.The relationship between competence of rapport building and communicationAs shown in graph 4 and table 9,students who were good at rapport building performed better in communication than those who were not.The result of Chi-square and the correlation analysis indicated that students who paid more attention to patient feelings got more confidence than those who paid more attention to patient's disease, especially in Express caring,concern,empathy and Listen and,Give pt undivided attention.SuggestionsThe measures should to be taken to improve medical students' communication skills and interpersonal skills.Firstly,medical schools should pay special attention to teach the humanities and social sciences such as Communication with Patient, Emotional Quotient Education and so on.Secondly,the medical students are to be encouraged to take part in more activities after class,for example,role-playing of doctor and patient in drama.Thirdly,teaching clinic communication skills needs to pay high should be highly attached importance to for the teachers who teach medical students in hospital.Last but not the least importance,medical schools are under an obligation to help teachers to develop effective teaching methods,e.g.Problem-Based Learning.Conclusion1.The SEGUE Framework are applicable to assess medical students' communication skills in China.2.Too many students pay too much attention to themselves rather than the patients' feeling and Perspective.3.The students' communication skills in CMU was poor4.Students' communication skills in some American medical schools were much higher than that of in CMU.5.Students who were good at rapport building performed better in communication than those who were not,especially those who were good at in Express caring,concern, empathy and Listen and,Give pt undivided attention.
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