Development and validation of a structured checklist for evaluating verbal, nonverbal, and para verbal communication skills in undergraduate medical students
Creators: name: Chauhan, Archana
name: Jarina Begum
name: Shaistha Saiyad
Publisher: name: F1000 Research Limited
Year: 2024

description: <b>Background:</b> Effective communication skills are crucial for medical professionals, yet evaluating these skills in early medical students can be challenging due to the limitations of existing assessment tools. Many current tools are designed for advanced clinical interactions, which may not align with the needs of first and second-year MBBS students. This study addresses this gap by developing and validating a tailored observation-based communication skills checklist specifically for early learners. The focus was on three core communication dimensions: verbal (VC), nonverbal (NVC), and para verbal communication (PVC).<br>
<b>Intervention:</b> A novel observation-based checklist, the Observation-Based Communication Skill Checklist (OCSC 1.0), was created and trialed among 84 first-year MBBS students at Dr. Yashwant Singh Parmar Government Medical College in Nahan, Himachal Pradesh, India. The checklist was crafted through both inductive and deductive approaches, including a review of existing literature and expert interviews. Initially comprising 68 items across 10 domains, the checklist underwent two Delphi rounds with nine medical education experts to refine its clarity, essentiality, and relevance.<br>
The final version, OCSC 3.0, consists of 35 items divided into four medical interviewing sections: “Sets up an interview,” “Opens an interview,” “Conducts an interview,” and “Closes an interview.” It includes eight domains: Rapport Building (5 items), Introduction (3 items), Clarity (4 items), Attention (8 items), Responsiveness (5 items), Empathy (3 items), Support (5 items), and Summarization (2 items). This checklist demonstrated strong internal consistency (Cronbach’s alpha of 0.91), content validity (0.78), and face validity (0.80). For accuracy, OCSC 3.0 was translated into Hindi and back-translated into English.<br>
During implementation, a large-group teaching session was conducted, showing students video clips illustrating "good" and "bad" communication behaviors. Students used the OCSC 3.0 handout to rate the behaviors, aligning their observations with the checklist.<br>
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One week later, the performance of the study participant(n=84) was assessed using OCSC 3.0  in an Objective Structured Clinical Examination (OSCE) station for communication skill assessment, scored by five trained faculty observers with consistent case types. The performance was evaluated on a binary scale (yes = 1 point; no = 0 points) of the OCSC 3.0, with immediate feedback provided.<br>
Faculty perceptions of the OCSC 3.0 checklist were assessed through focus group discussions using the structured guide, while student feedback was collected using a validated five-point Likert scale questionnaire.<br>
The results of the communication skill assessment by OCSC 3.0 indicated that students performed &gt;80% of all checklist domains except empathy (73%) and support (74%). Both students and faculty found the checklist effective for assessing communication skills, appreciating its thoroughness, user-friendly layout, and clear scoring system.<br>
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<b>Recommendation:</b> To enhance communication skills among early-phase MBBS students, it is recommended that the OCSC 3.0 checklist be integrated into regular OSCE stations. Emphasis should be placed on providing continuous feedback and targeted training, particularly in the areas of empathy and support. Regular updates to the checklist, informed by user feedback, will ensure its ongoing relevance and effectiveness in assessing communication skills in medical education.