In terms of teaching communication skills, the strategies that one can use range from purely didactic approaches to ones which are more experiential in nature. Quirk & Letendre (1986) describe a communication skills course for first year medical students. The use of videotape and simulated patients were used to develop verbal and non-verbal communication skills. Students rated role playing and the observation and analysis of the recorded interviews as significantly more valuable than readings or lectures. The students also rated the actors as more valuable than fellow students as simulated actors.
With respect to communication skill training, the use of SPs has been used quite effectively in health professional education (Barrows, 1993; Gold et al, 1995; Hasle et al, 1994; Heaton et al, 1994; Sanson-Fisher & Poole, 1980; Schultz et al, 1988). Barrows (1993) utilised SPs in conjunction with videotape recordings of the interaction. He found the videotape playbacks to be a very powerful tool for stimulating students' recall and reflection.
Student comments about the use of SPs in their training is also very positive (Gold et al, 1995; Hasle et al, 1994; Kaiser & Bauer, 1995; Schultz et al, 1988) although stress associated with this type of learning activity is not uncommon. In spite of this anxiety, Hasle (1994) demonstrated that participation in the SP program leads to a reduction in anxiety when students are then required to perform tasks on real patients.
Barrows (1993) describes the educational advantages of SPs. Specific problems can be chosen in advance to highlight parts of the curriculum and they can be manipulated in several different ways depending upon the desired educational outcome. Often, students may not encounter these types of problems in the clinical setting so the use of SPs ensures that all students have access to important clinical scenarios. Barrows (1993) goes on to state that students are able to get unique forms of objective and subjective feedback from videotape reviews and SP comments. Difficult and emotionally charged interpersonal situations can also be modelled using SPs.
The advantages and disadvantages of peer assessment have been summarised by several authors (Fry, 1990; Orpen,1982; Rushton et al, 1993; Boud, 1986; Williams, 1992; Falchikov, 1986). Advantages centre around reductions in the teacher's marking workload, students think more deeply about the exercise and get to view how others tackled the same problem, students learn how to constructively criticise the work of others and the gap between teacher and student narrows with the instructor viewed more positively as a facilitator. Disadvantages are that students may not have the same level of understanding as the teacher, may not provide useful feedback, need clearer guidance in terms of what they should look for, may show bias towards their friends and be reluctant to award low marks for poor work because of fear of offending peers.
Four actors were trained by one of the unit coordinators using scripts that had been developed by the academic staff in the School of Physiotherapy. These 4 SP scenarios were further developed by one of the Unit Coordinators to stimulate a variety of communication behaviours in the students. An emphasis was placed on the psychosocial elements of each clients' history as this was the prime focus of the unit.
Four tutorial sessions on communication principles, interviewing and counselling skills were presented by the students following Dickson & Maxwell's (1985) model of sensitisation and feedback. Following these tutorials, students undertook their interview with the simulated patient under videotape. When all students had completed their interview, the videotapes were exchanged amongst the student peers. Each student was required to review one videotape of a peer and to make comments on a marking sheet that had been developed by the unit coordinators.
The experiential nature of the unit and the focus on issues of immediate relevance to the students - another tenet of adult learning theory - was central to eliciting the student's interest and support for the program. The SPs were very effective in drawing out the desired behaviour in students which added depth to the concepts covered in the course. Greater self awareness about one's own communication skills was also a direct product of the exercise. Many students became aware of behaviours or mannerisms in their communication style which they did not expect or necessarily like. This 'awareness' is consistent with the findings cited by Barrows (1993) and Dockrell (1988) and further reinforces the positive effects of SPs in communication skill training.
The peer assessment process produced some interesting information. The students themselves were an excellent source of information about how the process could have been improved. Some of the strategies that will be included in future programming include: more specific marking guidelines, appointment of the unit controllers as dispute mediators, review of a couple of student-SP interactions on videotape to prepare students for the experience and the marking exercise that follows and the incorporation of the SP's mark into the overall grading strategy.
In terms of disadvantages, some students did not provide useful written feedback to their peers. The group was also very generous in their allocation of marks. Marks were significantly higher in the student group sample as compared to the grades awarded by the unit coordinators for this same sample. There was also less variation in the students' marks - clustering around a high average grade. This tendency to award peers high marks was consistent with findings cited by Williams, 1992; Falchikov, 1986 and Orpen, 1982.
The suggestion from some of the students that the peer assessment be a group (n=4) process may prove to be effective in minimising the mark discrepancy that occurred in this particular instance. The presence of other colleagues during the videotape review process will hopefully produce more objectivity in marking as well as pressure to provide responsible and useful feedback.
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|Please cite as: Ladyshewsky, R. and Gotjamanos, E. (1996). Communication skill development in health professional education: The use of standardised patients in combination with a peer assessment strategy. In Abbott, J. and Willcoxson, L. (Eds), Teaching and Learning Within and Across Disciplines, p93-97. Proceedings of the 5th Annual Teaching Learning Forum, Murdoch University, February 1996. Perth: Murdoch University. http://lsn.curtin.edu.au/tlf/tlf1996/ladyshewsky1.html|