Letter to the Editor

Keeping it simple ± audiotaping in consultationperformance assessment

The assessment of communication

performance is increasingly recognised

as central in acute hospital specialities.

We wished to measure this in Paediatric

Senior House Of®cers (SHOs) using the

Maastricht history-taking and advice

checklist (MAAS Global).1

Video techniques are well-described

but their use in the secondary care set-

ting poses challenges not faced by

research conducted in general practice

and psychiatry. They work best with

well-sited equipment in an appropri-

ately sized and shaped room.

Paediatric SHOs mostly communi-

cate on wards and during emergency

consultations. In the study hospital,

Accident and Emergency (A & E)

patients and General Practice referrals

are seen in four small rooms and a cur-

tained bay. All are in continuous use by

multiple specialities, two are too small to

easily site a movable camera and rooms

cannot be allocated to a given doctor.

Video observation of an SHO would

have required static and expensive

equipment in all rooms and explanation

to and by approximately 60 staff of

other specialities using those rooms. By

comparison, audio equipment is cheap,

easily moved, is unobtrusive and can be

set up instantly without the need to

check inclusion in the picture.

To assess what effect audio taping

would have on test scores, we video

taped 15 consultations and audio taped

80 consultations. The video taped

consultations were scored against the 12

relevant domains of MAAS-Global

twice, by one scorer (CM), using the

sound alone on one occasion and both

sound and vision on the other. The two

scorings were done three months apart

and whether each consultation was

scored ®rst by sound or by both sound

and vision was randomized. Informed

consent was undertaken and the num-

ber withholding consent recorded.

Results

The scores on sound alone and with

sound and vision for the video consul-

tations were compared using the Wil-

coxon Matched-Pairs Signed-Ranks

test. The scores were very similar

(P � 0á95, indicating the null hypo-

thesis, that the scores were the same, to

be highly likely). Scoring of video taped

consultations was therefore unaffected

by using sound alone.

A signi®cantly larger number of

families approached consented to audio

taping (97%) than video taping (73%),

Chi squared 15á3 with 1 degree of free-

dom, P � 0á00009. Ethical constraints

did not allow us to record information

where consent was withheld. However,

withholding of consent to video taping

could result in bias as it is likely to be

associated with particular types of cases.

Performance assessment can there-

fore be undertaken using the simpler

and cheaper technique of audio taping

in circumstances where video observa-

tion is dif®cult. This may be particularly

relevant internationally, if equipment

supply is dif®cult. Consent bias may

also be reduced.

AcknowledgementWe gratefully acknowledge the assist-

ance of the SHOs and A & E staff of

Sunderland Royal Hospital, and the

support of Dr Andy Mellon.

Colin Macdougall

University Hospital of North Tees,

Stockton on Tees, UK

Cath O'Halloran

Southampton General Hospital,

University of Southampton,

Southampton, UK

Reference1 Van Thiel J, van der Vleuten C,

Kraan H. Assessment of medical

interviewing skills: generalizability

of scores using successive MAAS-

versions. In: R Harden, I Hart, H

Mulholland, eds. Approaches to the

Assessment of Clinical Competence.

Dundee, Scotland: Proceedings of the

Fifth Ottawa Conference; 1992.

Correspondence: Colin Macdougall, Family

Health Division, University Hospital of

North Tees, Hardwick, Stockton on Tees.

TS19 8PE, UK. Email: Colin@doctors.co.uk

Ó Blackwell Science Ltd MEDICAL EDUCATION 2001;35:1091 1091