Association for Surgical Education
Identification of communication apprehension in medical students starting a surgery rotation

Presented at the annual meeting of the Association for Surgical Education, Philadelphia, April 1997.
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Abstract

Background: Most methods used to critically evaluate young surgeons for advancement or certification in surgery require oral communication skills, eg, case and research presentations, rounds, morbidity and mortality conferences, interviews, journal clubs and oral examinations. The irony, though, is that much of surgery training focuses on technical skill lists, and the rhetorical aspects are often neglected until the surgeon encounters failure in an oral examination or is sued for not “talking” appropriately. Early identification of those at risk for difficulty with oral skills would provide programs with time needed to arrange for the appropriate types of interventions. Therefore, the purpose of this study was to identify those medical students with high communication apprehension scores in dyadic, group, or public speaking situations before they encountered failure and caused problems, not only for themselves, but also for their programs and practices.

Methods: Two scales, Willingness to Communicate (WTC) and the Personal Report of Communication Apprehension (PRCA-24), were administered to medical students at two large university medical centers during new student orientation to the surgery rotation. The WTC is a 20-item probability-estimate scale designed to measure one’s predisposition toward approaching or avoiding the initiation of communication. The PRCA-24 is a scale designed to measure one’s fear associated with either real or anticipated communication in four different contexts. In addition to the 44 items, a lengthy list of demographic items was added for possible correlations. These items were based on the student’s perception of the communication or language environment in which he was raised. Therefore, a student ranked past and future socioeconomic status (eg, blue collar or white collar) according to his or her own criteria. The chairman was provided with a list of individual scores. Those students who were below the group means on skills required during a surgery rotation were identified for immediate intervention.

Results: The published data show a norm mean of 65.6 for PRCA-24 and 65.2 for WTC for college students. The current study found medical students to be more willing to communicate (WTC) and less anxious about communication (PRCA-24) than college students (mean 70.7 versus 65.2, P = 0.003, and 61.6 versus 65.6, P = 0.01, respectively). This difference was accentuated for blue-collar medical students compared with college students and persisted when blue-collar medical students were compared with white-collar medical students (73.9 blue-collar versus 70.9 college students, P = 0.15 for WTC, and 58.5 blue-collar versus 63.6 white-collar, P = 0.002 for PRCA-24). Male medical students were found to be less anxious about communication than female medical students.

Conclusions: These instruments are easily administered at orientation and produce simple class lists with individual scores. They can be used to identify students who are below the mean for specific forms of communication before they encounter failure.

Section snippets

Methods

Two scales that measured apprehension were selected for use in this study: The Personal Report of Communication Apprehension-24 (PRCA-24) and the Willingness to Communicate (WTC) scales.19 These scales were selected because of their published reliability and validity and consistent results among different populations and cultures.20, 21, 22 The PRCA-24 has high interim reliability (alpha >0.90), the four subscales (alpha >0.85) and strong evidence of criterion validity. The WTC has strong

Results

Eighty-one students entering their surgery rotation completed the two-sided scannable sheet containing the WTC, PRCA-24, and the demographic items. However, since eight forms were missing items, only 73 subjects were entered into the analysis. Initial results produced individual total scores on both scales for every student. Those who fell below the standard means were easily identified.

Comparisons were then made between the third- and fourth-year medical students and standard means for college

Comments

One of the criticisms of modern medical education in the United States is that it tends to isolate young physicians, and especially surgeons, from the general population through important years of adult social development. Young physicians tend to socialize with other physicians who share similar schedules and academic backgrounds. Sociology studies in the 1970s found physicians to be “socially immature” as compared with the rest of the population due, researchers speculated, to this isolation.

Summary

This study demonstrates two different scales of communication apprehension that may have value for a clerkship or program director. Since many medical schools do not require an interview for admission, this type of scoring method would establish guidelines for earlier detection of problems and appropriate referrals could be made. Large groups could be processed quickly and efficiently. Current practice usually allows a surgeon to progress until a complaint in some activity (eg, oral examination

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