Open Access Highly Accessed Research article

Identifying context factors explaining physician's low performance in communication assessment: an explorative study in general practice

Geurt Essers1*, Sandra van Dulmen2, Chris van Weel1, Cees van der Vleuten13 and Anneke Kramer1

Author Affiliations

1 Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, (Geert Groteplein 21), Nijmegen, (6525 EP), The Netherlands

2 Netherlands Institute for Health Services Research NIVEL, (Otterstraat 118-124), Utrecht, (3513 CR), The Netherlands

3 Department of Educational Development and Research, Maastricht University, (Universiteitssingel 60), Maastricht, (6229 ER), The Netherlands

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BMC Family Practice 2011, 12:138  doi:10.1186/1471-2296-12-138

Published: 13 December 2011



Communication is a key competence for health care professionals. Analysis of registrar and GP communication performance in daily practice, however, suggests a suboptimal application of communication skills. The influence of context factors could reveal why communication performance levels, on average, do not appear adequate. The context of daily practice may require different skills or specific ways of handling these skills, whereas communication skills are mostly treated as generic. So far no empirical analysis of the context has been made. Our aim was to identify context factors that could be related to GP communication.


A purposive sample of real-life videotaped GP consultations was analyzed (N = 17). As a frame of reference we chose the MAAS-Global, a widely used assessment instrument for medical communication. By inductive reasoning, we analyzed the GP behaviour in the consultation leading to poor item scores on the MAAS-Global. In these cases we looked for the presence of an intervening context factor, and how this might explain the actual GP communication behaviour.


We reached saturation after having viewed 17 consultations. We identified 19 context factors that could potentially explain the deviation from generic recommendations on communication skills. These context factors can be categorized into doctor-related, patient-related, and consultation-related factors.


Several context factors seem to influence doctor-patient communication, requiring the GP to apply communication skills differently from recommendations on communication. From this study we conclude that there is a need to explicitly account for context factors in the assessment of GP (and GP registrar) communication performance. The next step is to validate our findings.