Unannounced simulation to evaluate communication and interpersonal skills among neurology residents

The teaching and evaluation of behaviorally-mediated competencies such as communication and interpersonal skills remains challenging due to the lack of a standardized and effective approach, in addition to uncertainty regarding the role of assessment bias. In this proposal, I aim to utilize unannounced simulation as a means to optimize the validity and relevance of assessment. Without the resident’s knowledge, I will insert standardized actors into routine clinical scenarios as a novel tool to assess specific communication and interpersonal skills. Unannounced patient simulation has been previously regarded as a candidate “gold standard” in assessing the quality of clinical encounters.1, 2 Residents will be consented to participate but will not know the details of when or where the simulated encounters will occur. The scenarios will be covertly audio-recorded and trained raters will evaluate the encounters using a the Kalamazoo Essential Elements Communication Checklist (Adapted). The role of bias will be ascertained through analysis of self-ratings by the resident as compared to a departmental faculty member familiar with the resident and a faculty member at another institution who has had no contact with the resident. The recordings will be utilized for directed education with specifically defined learning goals and objectives for each simulation event. Over the 2 years of the study, I will evaluate all 15 PGY2-4 residents semiannually, for a total of 4 unannounced simulation protocols evaluating challenging patient scenarios (e.g. a clinic patient with a psychogenic movement disorder).