Open Access Research article

Context factors in general practitioner - patient encounters and their impact on assessing communication skills - an exploratory study

Geurt Essers19*, Anneke Kramer1, Boukje Andriesse2, Chris van Weel13, Cees van der Vleuten1456 and Sandra van Dulmen178

Author Affiliations

1 Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands

2 Bureau BRIES, Independent consultancy for primary care, Nieuwkoop, The Netherlands

3 Australian Primary Health Care Research Institute, Australian National University, Canberra, Australia

4 Department of Educational Development and Research, Maastricht University, Maastricht, The Netherlands

5 Northumbria University, Newcastle upon Tyne, UK

6 Copenhagen University, Copenhagen, Denmark

7 NIVEL (Netherlands Institute for Health Services Research), Utrecht, The Netherlands

8 Department of Health Science, Buskerud University College, Drammen, Norway

9 Department of Primary & Community Care, Radboud University Nijmegen Medical Centre, Geert Grooteplein 21, 6525 EP Nijmegen, The Netherlands

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BMC Family Practice 2013, 14:65  doi:10.1186/1471-2296-14-65

Published: 22 May 2013



Assessment of medical communication performance usually focuses on rating generically applicable, well-defined communication skills. However, in daily practice, communication is determined by (specific) context factors, such as acquaintance with the patient, or the presented problem. Merely valuing the presence of generic skills may not do justice to the doctor’s proficiency.

Our aim was to perform an exploratory study on how assessment of general practitioner (GP) communication performance changes if context factors are explicitly taken into account.


We used a mixed method design to explore how ratings would change. A random sample of 40 everyday GP consultations was used to see if previously identified context factors could be observed again. The sample was rated twice using a widely used assessment instrument (the MAAS-Global), first in the standard way and secondly after context factors were explicitly taken into account, by using a context-specific rating protocol to assess communication performance in the workplace. In between first and second rating, the presence of context factors was established. Item score differences were calculated using paired sample t-tests.


In 38 out of 40 consultations, context factors prompted application of the context-specific rating protocol. Mean overall score on the 7-point MAAS-Global scale increased from 2.98 in standard to 3.66 in the context-specific rating (p < 0.00); the effect size for the total mean score was 0.84. In earlier research the minimum standard score for adequate communication was set at 3.17.


Applying the protocol, the mean overall score rose above the level set in an earlier study for the MAAS-Global scores to represent ‘adequate GP communication behaviour’. Our findings indicate that incorporating context factors in communication assessment thus makes a meaningful difference and shows that context factors should be considered as ‘signal’ instead of ‘noise’ in GP communication assessment. Explicating context factors leads to a more deliberate and transparent rating of GP communication performance.

Communication and Interviewing skills; Continuing Medical Education; Graduate Medical Education; Assessment of Learner Performance