Validity Evidence Supporting the Comunicación y Habilidades Interpersonales (CAI) Scale for Medical Spanish Communication and Interpersonal Skills Assessment

While many schools teach medical Spanish to improve communication with the growing Spanish-speaking population, a standardized assessment methodology is lacking. This study evaluates validity evidence for a newly developed Spanish Communication and Interpersonal Skills (CIS) scale. The authors developed the Comunicación y Habilidades Interpersonales (CAI, pronounced /kī/) scale by culturally and linguistically adapting a 14-item validated English CIS scale. Sources of validity evidence were gathered targeting content, response process, internal structure, relations to other variables, and consequences. The CAI was administered as part of an objective structured clinical examination at 2 medical schools from April to June 2020. The authors mapped CAI items onto USMLE Step 2 CIS behavioral functions and medical Spanish learner competencies to examine content validity. The mean item difficulty and item discrimination estimates are 2.86 (SD = 0.34) and 0.81 (SD = 0.08), respectively, demonstrating good psychometric properties at the item level. Internal-consistency reliability for a single case was 0.96. Learner variance accounted for 12% of total variance, demonstrating ability to differentiate higher and lower performing learners; the person-case interaction accounted for 44% of total variance, indicating strong case specificity. The CAI has higher case specificity than previously reported in English, suggesting that the nuanced contextual elements of individual cases may matter even more when learners are using limited language skills. Implementing the CAI more widely may promote inclusion of patient-centered communication skills as part of curricular content and activities. This study's validity evidence may inform the development of a future medical Spanish certification examination.