Introduction: I am a general practitioner in solo practice in Athlone. I work closely with a qualified nursing sister. Many of the patients we attend to have non-insulin dependent diabetes mellitus. Aim: To implement change in the management of our patients with diabetes by developing a protocol for future improved care. Objective: To assess the quality of care provided to patients with (NIDDM), by a doctor - nurse team in private general practice. Method : The study was quantitative and qualitative and consisted of 3 sections : 1) an internal audit based on the retrospective examination of patients' medical records, 2) a questionnaire which was administered to determine patients' knowledge of their disease and 3) a focus group interview which centred around patients' experience of the disease and feelings about the service provided. The interview was audio taped. Findings: Problem areas identified were sub-optimal record keeping; poor attendance and infrequent eye and foot examinations; patients' knowledge of their disease was limited; certain aspects of doctor-patient and patient-family relationships that may impact negatively on care; fears and anxieties relating to the disease and perceptions oflocus of control as external.

Indiana University-Purdue University Indianapolis (IUPUI) / In relationship-centered care, the relationship formed between physician and patient is critical to the creation of positive patient outcomes and patient satisfaction (Inui, 1996; Laine & Davidoff, 1996; Tresolini, 1994). Medical educators have increasingly utilized Objective Structured Clinical Examinations (OSCEs) to assess medical students’ abilities to utilize a relationship-centered approach in clinical interviewing. OSCEs, however, have recently come under scrutiny as critics contend that the overly scripted and standardized nature of the OSCE may not accurately reflect how medical students build and maintain relationships with patients. Although some studies have looked at how standardized patients help teach medical students interviewing skills, few studies have looked specifically at how the structured nature of the OSCE may influence relationship-building between standardized patients and medical students. Therefore, this study asks the question “How is relationship-centered care negotiated between standardized patients and medical students during a summative diagnostic OSCE?” Using an ethnographic methodology (Bochner & Ellis, 1996), data consists of an ethnographic field journal, transcripts of semi-structured interviews with SPs and medical students, and transcripts of headache and chronic cough videotaped scenarios. Using grounded theory (Strauss & Corbin, 1990, 1998), a back-and-forth thematic analysis was conducted in discovering the saturation of conceptual categories, linking relationships, and in critically comparing interpretive categorical concepts with relevant literature (Josselson & Leeblich, 1999). Findings suggest that standardized patients and medical students hold differing expectations for 1) diagnostic information gathering and 2) making personal connections upon entering a diagnostic summative OSCE. SPs “open up” both verbally and nonverbally when medical students “go beyond the checklist” by asking discrete diagnostic questions and when overtly trying to connect emotionally. Fourth year medical students, however, expect SPs to “open-up” during what they experience as a rushed, time-constrained, and overly structured “gaming” exercise which contradicts their own clinical experiences in being more improvisational during empathetic rapport building. Differences between SPs and medical students’ expectations and communication practices influence how they perform during summative diagnostic OSCEs. Findings may suggest the re-introduction of more relationship-focused OSCEs which positions SPs as proactive patients who reflexively co-teach students about the importance of making personal connections.

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OBJECTIVES: Tools are needed for determining appropriate weights for complex performance assessment components in medical education. The feasibility of using judgmental policy capturing (JPC), a procedure to statistically describe the information processing strategies of experts, for this purpose was investigated. METHODS: Iterative JPC was used to determine appropriate weighting for the six core communication skill scores from a communications objective structured clinical examination (OSCE) for medical students using a panel of four communication skill experts. RESULTS: The mean regression weights from the panel indicated they placed less importance on information management (8.5%), moderate and nearly equal importance on rapport building (15.8%), agenda setting (15.4%), and addressing feelings (14.1%), and greater importance on active listening (20.1%) and reaching common ground with the patient (25.5%). DISCUSSION: JPC is an effective procedure for determining appropriate weights for complex clinical assessment components. The derived weights may be very different for those assessment components.

A positive physician-patient relationship is crucial for high quality and effective health care. Yet, cultural and language differences between providers and patients often challenge the establishment of effective physician-patient relationships. These challenges are especially evident in provider-refugee-patient interactions in which patients have experienced loss, torture, and trauma. Understanding of what constitutes a positive doctor-patient relationship is fundamental to diagnosis and treatment and is crucial for the delivery of quality care for diverse patient populations, including refugees. This qualitative, phenomenological case-study focuses on physician-reported experiences caring for refugees in order to identify what experiential factors contribute to effective therapeutic relationships.

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