New Test Assesses the Ability to Deliver Patient-Centered Care

A newly developed tool assesses whether medical students have learned and are applying specific behaviors that characterize patient-centered care (PCC).

Researchers at the University of Missouri (MU; Columbia, USA) developed the PCC-objective structured clinical exam (PCC-OSCE) with the purpose of creating a credible tool to objectively assess the patients’ perspectives in describing behaviors essential for effective PCC. To do so, they first developed PCC descriptors that included patient perspectives; they then constructed scenarios for third-year medical students to demonstrate PCC and used the patient perspective to validate the assessment tool.

To apply the test, a standardized patient (an actor) was trained to take on characteristics of a real patient and portray the roles of patients, family, and others. The students are tested on how they interact with standardized patients ranging from adolescents to senior citizens, how to solicit information from the patient, and how to create a management and care plan that reflects the patient's preferences. The test results showed that most MU medical students had strong, effective communication skills, actively listened to the patient, showed empathy, and were in charge of the situation when they needed to lead a critical conversation.

The researchers established that both faculty and students found the PCC-OSCE to be an authentic experience. Students received abundant individualized feedback and demonstrated strong performances, with patient critiques of exemplary performances confirming that the PCC-OSCE effectively assessed the elements the patients viewed as essential to PCC. As a result, students must perform at a satisfactory level on the PCC-OSCE exam to graduate from the MU School of Medicine. The study was published early online on August 26, 2014, in Medical Teacher.

“We developed very real, complex scenarios. The test uses standardized patients, standardized family members and standardized health providers to simulate real-life situations,” said lead author Kimberly Hoffman, PhD, a research associate professor of family and community medicine at MU. “The test forces the future physician to go beyond just determining a diagnosis and to focus on behaviors that play an essential role to the effectiveness of the care he or she provides.”

“By the time we take the exam in our third year, we are all confident we have the skill set or developed this skill over the course of the last two to three years,” added Joshua Geltman, a third-year medical student who is also president of his MU medical school class. “Patient-centered care is our default, it's our baseline; that's the way we have learned how to become a physician. Now it is just the norm, not a separate skill set because it is included in every aspect of what we have learned in medical school.”

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