Development of the Objective, Structured Communication Assessment of Residents (OSCAR) Tool for Measuring Communication Skills With Patients

AbstractBackgroundAlthough interpersonal and communication skills are essential to physician practice, there is a dearth of effective tools to meaningfully teach and assess communication skills.ObjectiveThe purpose of our study was to create a standardized tool for evaluation of communication skills for residents across specialties.MethodsWe designed an Objective, Structured Communication Assessment of Residents (OSCAR) tool, consisting of 4 clinical stations, to assess intern communication skills with relationship development, their establishment of case goals, and their organization and time management skills. Interns from 11 training programs completed the stations, with senior residents trained to function as standardized patients. The 4 stations' scenarios were a disruptive patient, handling a phone call for a narcotics refill, disclosing a medical mistake, and delivering bad news.ResultsEighty-three interns completed OSCAR during orientation. The assessment took interns about 40 minutes to complete, and participants were given immediate feedback by the standardized patients. The total possible score for each station was 50. Resident performance was highest for disclosing a medical error (94%, 47 of 50), followed by handling a disruptive patient (90%, 45 of 50), disclosing bad news (86%, 43 of 50), and handling the phone call for the narcotics refill (62%, 31 of 50). Multivariate analysis of variance results indicated differences between residents from US and international medical schools, but there were no significant differences across specialties. Interrater reliability was excellent for each station (&amp;gt; 0.80).ConclusionsOSCAR is a practical tool for assessing interns' communication skills to provide timely results to program directors.</jats:sec

Psychosocial Features of Clinically Relevant Patient Subgroups With Serious Mental Illness and Comorbid Diabetes

OBJECTIVE: Care for people with serious mental illness and diabetes is complicated by clinical heterogeneity. This cross-sectional analysis of 200 individuals comorbid for serious mental illness and diabetes explored differentiation of patient sub-groups characterized on selected dimensions within a biopsychosocial framework. METHODS: Relationships between self-efficacy, treatment expectation, social support and psychiatric symptom severity were first assessed via bivariate Spearman correlations among 200 individuals participating in a randomized trial who have diabetes and major depression, bipolar disorder, or schizophrenia. Next, latent profile analysis were conducted to determine underlying subgroups based on these variables. The resultant groups were compared on diabetes control, function, and symptoms. RESULTS: In the two sub-groups, group A was high on psychiatric symptoms, low on other psychosocial variables and had worse diabetes control. Group B was low on depression and high on other variables and had better diabetes control. CONCLUSIONS: Symptom presentation, internal and external resources appear related to diabetes control in people comorbid for diabetes and serious mental illness. Care approaches need to go beyond standard education and consider biopsychosocial variables

Measuring Disparities

BACKGROUND: Many national surveys have found substantial differences in self-reported overall health (SROH) between Spanish-speaking Hispanics and other racial/ethnic groups. However, because cultural and language differences may create measurement bias, it is unclear whether observed differences in SROH reflect true differences in health. OBJECTIVES: This study uses a cross-sectional survey to investigate psychometric properties of the SF-36v2 for subjects across four racial/ethnic and language groups. Multi-group latent variable modeling was used to test increasingly stringent criteria for measurement equivalence. SUBJECTS: Our sample (N = 1281) included 383 non-Hispanic whites, 368 non-Hispanic blacks, 206 Hispanics interviewed in English and 324 Hispanics interviewed in Spanish recruited from outpatient medical clinics in two large urban areas. RESULTS: We found weak factorial invariance across the four groups. However, there was no strong factorial invariance. The overall fit of the model was substantially worse (change in CFI > .02, RMSEA change > .003) after requiring equal intercepts across all groups. Further comparisons established that the equality constraints on the intercepts for Spanish-speaking Hispanics were responsible for the decrement to model fit. CONCLUSIONS: Observed differences between SF-36v2 scores for Spanish speaking Hispanics are systematically biased relative to the other three groups. The lack of strong invariance suggests the need for caution when comparing SF-36v2 mean scores of Spanish-speaking Hispanics with those of other groups. However, measurement equivalence testing for this study supports correlational or multivariate latent variable analyses of SF-36v2 responses across all four subgroups, since these analyses require only weak factorial invariance

Clinical Characteristics of Individuals With Serious Mental Illness and Type 2 Diabetes

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Associations between comorbid anxiety, diabetes control, and overall medical burden in patients with serious mental illness and diabetes

Objective While previous work has demonstrated elevation of both comorbid anxiety disorders and diabetes mellitus type II in individuals with serious mental illness, little is known regarding the impact of comorbid anxiety on diabetes mellitus type II outcomes in serious mental illness populations. We analyzed baseline data from patients with serious mental illness and diabetes mellitus type II to examine relationships between comorbid anxiety, glucose control as measured by hemoglobin A1c score, and overall illness burden. Methods Using baseline data from an ongoing prospective treatment study involving 157 individuals with serious mental illness and diabetes mellitus type II, we compared individuals with and without a comorbid anxiety disorder and compared hemoglobin A1c levels between these groups to assess the relationship between anxiety and management of diabetes mellitus type II. We conducted a similar analysis using cumulative number of anxiety diagnoses as a proxy for anxiety load. Finally, we searched for associations between anxiety and overall medical illness burden as measured by Charlson score. Results Anxiety disorders were seen in 33.1% ( N = 52) of individuals with serious mental illness and diabetes mellitus type II and were associated with increased severity of depressive symptoms and decreased function. Hemoglobin A1c levels were not significantly different in those with or without anxiety, and having multiple anxiety disorders was not associated with differences in diabetes mellitus type II control. However, depressive symptoms were significantly associated with higher hemoglobin A1c levels. Neither comorbid anxiety nor anxiety load was significantly associated with overall medical burden. Conclusion One in three people with serious mental illness and diabetes mellitus type II had anxiety. Depressive symptoms were significantly associated with Hb1Ac levels while anxiety symptoms had no relation to hemoglobin A1c; this is consistent with previously published work. More studies are needed to better understand the relationship between depression, anxiety, and health management in people with serious mental illness and diabetes mellitus type II. </jats:sec