Kaushik and Pothier raise 2 important issues. First, how should researchers assess communication skills training? We think that assessment should occur at 2 levels: (A) Does the training change physician communication behaviors? and (B) Do the changes improve patient-level outcomes? Our study was designed to address question A. Our study design using standardized patients to answer this question has strengths and weaknesses. A weakness of using standardized patients is that physicians in real life may behave differently than in a simulated situation. Clearly, an important next step would be to examine trained physicians in their own clinics, as was done by Fallowfield et al,1 who showed that physicians given a similar type of training (small groups with trained facilitators) in fact used their new skills in real settings at statistically significant levels. An important strength of using standardized patients is that, in our study, they were scripted to provide cues so that the physicians had consistent opportunities to demonstrate their skills. Thus, acquisition of new behaviors can be measured more precisely, and we think this approach provides an economical way to rapidly test new training models.
Back A, Arnold R, Tulsky J. A Partial Solution to a Big Problem—Reply. Arch Intern Med. 2007;167(20):2262. doi:10.1001/archinte.167.20.2262-a