Observation scheme 12

Observation Scheme–12 (OS-12) 是一套根據Calgary-Cambridge Guide (C-CG) 發展的臨床溝通技巧評估工具，目標為透過具體化的評分標準提升對醫療專業人員溝通行為的觀察與評量一致性。

OS-12 包含12個項目，涵蓋會談的六大面向：

• initiating the session
• gathering information
• building the relationship
• explanation and planning
• providing structure
• closing the session.

每項目依據是否展現特定微技巧（micro-skills）給予0到4分不等的評分。

OS-12可應用於音檔評分，特別適合用於臨床溝通訓練成效的前後比較，亦可作為教育評量或研究使用的工具。

Codebook with Criteria for Points Allocated to Each Item (OS-12)

Initiating the Session

Item 1: Identifies problems the patient wishes to address

• Micro-skills
  1. Greets patient
  2. Introduces oneself, one’s role and the nature of the interview
  3. Demonstrates respect and interest; attends to patient’s physical comfort
  4. Uses an appropriate opening question / listens attentively
  5. Confirms issues to be discussed / screens for further questions and negotiates the agenda
• Points
  • 1: Micro-skill 1 and 2
  • 2: Micro-skill 1, 2 + one more
  • 3: Micro-skill 1, 2 + two more
  • 4: All micro-skills demonstrated

Gathering Information

Item 2: Clarifies the patient’s prior knowledge and desire for information

• Micro-skills
  1. Listens attentively
  2. Encourages the patient to tell the story
  3. Uses open and closed questioning appropriately
  4. Clarifies unclear statements
  5. Summarizes and invites corrections
• Points
  • 1: One micro-skill
  • 2: Two or three micro-skills
  • 3: Four micro-skills
  • 4: All micro-skills demonstrated

Building the Relationship

Item 3: Uses easily understood language, avoids jargon

• Micro-skills
  • (No specific micro-skills; assessed by number of medical jargon words used)
• Points
  • 1: 10 or more medical words
  • 2: 4–9 words
  • 3: 2–3 words
  • 4: 0–1 word

Item 4: Uses appropriate non-verbal behaviour

• Micro-skills
  • Calm speaking pace
  • No interruptions
  • Leaves space for patient to talk
  • Pausing
• Points
  • 1: One micro-skill
  • 2: Two micro-skill
  • 3: Three micro-skill
  • 4: All micro-skill

Item 5: Provides support: expresses concern and willingness to help

• Micro-skills
  • Accepts the legitimacy of the patient’s views and feelings; is not judgmental
  • Uses empathy to communicate understanding and appreciation of the patient’s feelings
  • Provides support: expresses concern, understanding, and willingness to help
• Points
  • 1: Some support but no specific micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Providing Structure

Item 6: Structures the interview in a logical sequence

• Micro-skills (Progresses from one section to another)
  • Signposting
  • Transitional statements
  • Explains rationale for next section
• Points
  • 1: Some structure, no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Item 7: Attends to timekeeping, and keeps the interview on track

• Micro-skills
  • Structures the interview based on C-CG
  • Attends to timing
  • Keeping the interview on track
• Points
  • 1: Some structure, no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Explanation and Planning

Item 8: Shares thoughts and reflections with the patient

• Micro-skills
  • Assesses patient’s starting point
  • Provides manageable information; checks understanding
  • Gives correct amount/type of information
• Points
  • 1: Some reflection, no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Item 9: Checks the patient’s understanding

• Micro-skills
  1. Organizes the explanation (uses summarizing)
  2. Assesses the patient’s understanding (asks the patient to summarize the information he/she was provided)
  3. Asks the patient what other information would be helpful, addresses patient’s needs for information
• Points
  • 1: Question asked but no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Item 10: Negotiates a mutual plan of action

• Micro-skills
  • Explores options
  • Involves patient in decision-making
  • Reaches mutual agreement
• Points
  • 1: Some negotiation, no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

Closing the Session

Item 11: Contracts with the patient about next steps

• Micro-skills
  • Contracts about next steps
  • Provides safety net (e.g., phone number)
• Points
  • 1: One micro-skill initiated but not completed
  • 2: One micro-skill completed
  • 3: One completed, one initiated
  • 4: All completed

Item 12: Summarizes the session briefly and clarifies the plan of care

• Micro-skills
  • Confirms patient understanding
  • Summarizes session and plan
  • Checks that patient agrees and is comfortable
• Points
  • 1: Some summary, no micro-skill
  • 2: One micro-skill
  • 3: Two micro-skills
  • 4: All micro-skills

reference

Iversen, E. D., Wolderslund, M. O., Kofoed, P.-E., Gulbrandsen, P., Poulsen, H., Cold, S., & Ammentorp, J. (2020). Codebook for rating clinical communication skills based on the Calgary-Cambridge Guide. BMC Medical Education, 20(1). https://doi.org/10.1186/s12909-020-02050-3