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Validity Evidence for communication skills assessment in health professions education: A systematic review

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Linda Dorrestein1
Caroline Ritter2, Zoë de Mol3, Maureen Wichtel2, Julie Cary4, Courtney Vengrin5, Elpida Artemiou5, Cindy Adams1 and Kent Hecker1,5
1 Faculty of Veterinary Medicine, University of Calgary
2 Atlantic Veterinary College, University of Prince Edward Island
3 Faculty of Veterinary Medicine, Ghent University
4 Faculty of Veterinary Medicine, Washington State University
5 International Council on Veterinary Assessment
6 Faculty of Veterinary Medicine, Texas Tech University




Background.
Communication skills (CS) are indispensable for health care providers and are related to better clinical outcomes; patient safety, satisfaction and compliance of patients and clients (1,2). However, psychometric evidence from scores of communication skills and knowledge assessment methods are typically housed within respective health professions, such as nursing, veterinary medicine, medicine, pharmacy. Therefore, the purpose of this systematic review was to consolidate reports of validity evidence by addressing following questions: What validity and reliability evidence of CS assessment methods to support high and low stakes decision making processes have been reported? And, what are the reported CS constructs, and associated assessment methods, that report validity evidence within and across health professions? 


Summary of work.
Medline, PsychINFO, Embase, CAB Abstracts, CINAHL, ERIC and Scopus databases, focussing on peer-reviewed journals in English, were searched for years 1990-2023 (3). Two authors independently screened articles for inclusion and extracted information on assessment features and validity evidence. 


Results.

17,000+ studies were screened, data were extracted from 161 studies. Assessment modalities featured simulated in person (67%) and virtual (15%) interactions, written tests (7%) and workplace-based assessments (7%). Validity was reported based on content (42%), internal structure (65%), and relationships with other variables (55%). 


Discussion.
CS assessment methods for knowledge and performance across health professions report varying levels of validity evidence across assessment methods for low and high stakes decision making. 


Conclusions.
Given content and case specificity issues, which reduces validity of performance- based exam scores, health professions are supplementing in person assessment methods with activities that could assist with validity concerns. 


Implications for further research or practice.
A synthesis of assessment methods that demonstrate reliable and valid scores could assist health professional programs, organizations, and licensure board in determining what CS components could be assessed given their respective jurisdictions and objectives. 



References (maximum three) 

1. Street RL, Makoul G, Arora NK, Epstein RM. How does communication heal? Pathways linking clinician–patient communication to health outcomes. Patient Educ Couns. 2009 Mar 1;74(3):295–301. 

2. Kanji N, Coe JB, Adams CL, Shaw JR. Effect of veterinarian-client-patient interactions on client adherence to dentistry and surgery recommendations in companion-animal practice. J Am Vet Med Assoc. 2012 Feb 15;240(4):427–36. 

3. Reed DA, Cook DA, Beckman TJ, Levine RB, Kern DE, Wright SM. Association Between Funding and Quality of Published Medical Education Research. JAMA . 2007 Sep 5;298(9):1002–9. 

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