Behavioral Coding for Evaluation of Medical Student Communication: Clarification or Obfuscation?

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To understand which specific student behaviors predict performance ratings from standardized patients and behavioral scientist preceptors.


In 1996–98, objective, real-time ratings of student verbal and nonverbal behaviors were conducted on 75 videotaped interviews between second-year medical students and standardized patients at University of North Carolina at Chapel Hill School of Medicine. The coding system used in these analyses was developed based on evidence-based literature reviews and used software that provides for real-time recording; 30 nonverbal and 33 behaviors were coded. The coded behaviors were then compared with four ratings: a global rating of the encounter by the standardized patient, a summary score derived from a checklist completed by the standardized patient, a global rating of the encounter by a behavioral science preceptor who observed the encounter, and a summary score derived from a checklist completed by the preceptor.


Analyses identified strong correlations between all four of the preceptor and patient ratings, a strong independent effect of case scenario, and significant between-rater variation. When multivariable analysis was used to predict these global ratings based on coding of specific behaviors, a relatively high proportion of observer variation was explained by a small group of coded behaviors.


This study suggests that the coding of specific behaviors may hold promise as a student evaluation technique thereby improving medical training techniques and ultimately enhancing the communication skills in physician–patient encounters. It also illustrates the need to better clarify which specific behaviors are most critical in influencing patient satisfaction.

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