Assessment of Attitudes and

Communication Skills
dr. M. Sidhartani
Medical Faculty Diponegoro University

Attitude

A tendency to behave in a preferential manner

Personal qualities of doctors and their attitude
toward health, patients, peers

Nature of Attitude

Constant traits of feeling, thinking, action

Guidance of behavior

Components of Attitude

Attitudes

Cognitive

What a person knows

and his belief about
the attitude object

Affective

How he feels about

the attitude
object

Conative

Behavioral tendency
towards the objectverbal and nonverbal

Assessment of attitude relates to :

Patient care
Formation of attitude of peers or juniors
Acceptance of new technology
Interpersonal skills
Curriculum planning
Its effect on meaningful learning and retention

Effect of Attitudinal Bias

Premature closure and dogmatic response

Evasion
Premature reassurance
Rejection
Condescension
Technical jargons : confuses patient

Measurement of Attitudes

Difficult
Different method : simple complex :
1. Self report
2. Attitude scales : Likert, Osgoods
3. Involuntary

Likert Scale
Five point scale :
1.
Strongly agree
2.
Agree
3.
Cannot decided
4.
Disagree
5.
Strongly disagree

Osgoods Scale

2 (two) opposite adjectives given with

gradations.
Example :
Behavioral sciences course in undergraduate
medical curriculum is :
Useful
Informative
Interesting
Relevant

..
..
..
..

Not useful
Not informative
Uninteresting
Irrelevant

Comparison Between Likert and

Osgoods Scales

Ease of construction

Likert : written, analyzed, scaling value

Osgood : adjectives

Amount of information

Likert : - more information

- various aspects : for & against

Comparison Between Likert and

Osgoods Scales (Cont)

Scoring & interpretation

5 point scale
Limited interpretation on Osgood scale

Uses : in medical research

Reliability & validity
Establish before use

Construction of Scales

Specify attitude variable that is to be measured

Collect wide variety of statement
Edit the statement
Sort out the statements into (an imaginary)
scale
Calculate the scale value

Guidelines
1.
2.
3.

4.

5.

6.

7.

The statement should be brief

Each statement should convey one complete thought
The statement should belong to the attitude variable
that is to be measured
The statements should cover the entire range of the
affective scale of interest
Statements should be such that they can be endorsed or
rejected (agree/disagree)
Acceptance and rejection should indicate something
about the attitude measured
Care should be taken on language (simple sentences,
avoid double negatives, avoid all, always, none or
never, use with care only, just, merely, avoid
words with more than one meaning)

Reliability and Validity

Do item validation of statement

Estimate reliability
Validity : content and construct
Use standard procedures : - test retest
- split half

Communication Skills

The doctor-patient relationship is created and

maintained
Verbal information relevant to the clarification
and solution of the patients problem is
gathered
The solution to the problem is negotiated

Assessment of Communication Skills

Evaluate :
1. Ability to understand his patient
2. Ability to communicate his view point to the patient
and his family members
3. Ability to explore and answer patients questions
(mind the patients frame of reference which
includes the psychological connotations of patients
complaints, his wishes, expectations and fears)
4. Ability to propose solutions to the problems and to
motivate patients for compliance with treatment

Strategies of Assessment of
Communication Skills
1.

2.

3.

Observation in routine setting, eg. during clinical

rounds
Observation in a structured situation; 10-15 minutes
interview session on a preselected topic; a checklist
can be prepared to assess the various components of
communication used/unused by the candidate
Listening triad: A role play exercise in which 3
students take the role of doctor, patient and a
observer. The observer records the ensuing
interviews which from the substance for discussion
and feedback

Strategies of Assessment of
Communication Skills (Cont)
4.

5.

6.

7.

Closed circuit TV monitors are used to assess the manner in

which a student interviews the patients.
Communication skills have also been assessed through OSCE
stations. Simulated or real patients may be used in the OSCE
stations. The assessment can be objectivised using a rating scale
or a check list
Students may be asked to maintain a log book, recording writeup of the various exercises and activities related to
communication. This is constantly supervised by the teaching
staff
The students may view the video-tape of an interview situation
and point out or answer to the specific questions, such as
nonverbal behavior of the patient.

Summative Assessment

Communication skill should be inbuilt into clinical assessment