Communication Assessment Tool Score Research Articles

Correlation of attending and patient assessment of resident communication skills in the emergency department.

Communication and interpersonal skills are one of the Accreditation Council for Graduate Medical Education's six core competencies. Validated methods for assessing these among trainees are lacking. Educators have developed various communication assessment tools from both the supervising attending and the patient perspectives. How these different assessment methods and tools compare with each other remains unknown. The goal of this study was to determine the degree of agreement between attending and patient assessment of resident communication skills. This was a retrospective study of emergency medicine (EM) residents at an academic medical center. From July 2017 to June 2018, residents were assessed on communication skills during their emergency department shifts by both their supervising attending physicians and their patients. The attendings rated residents' communication skills with patients, colleagues, and nursing/ancillary staff using a 1 to 5 Likert scale. Patients completed the modified Communication Assessment Tool (CAT), a 14-item questionnaire based on a 1 to 5 Likert scale. Mean attending ratings and patient CAT scores were calculated for each resident. Means were divided into tertiles due to nonparametric distribution of scores. Agreement between attending and patient ratings of residents were measured using Cohen's kappa for each attending evaluation question. Scores were weighted to assign adjacent tertiles partial agreement. During the study period, 1,097 attending evaluations and 952 patient evaluations were completed for 26 residents. Attending scores and CAT scores of the residents showed slight to fair agreement in the following three domains: patient communication (κ= 0.21), communication with colleagues (κ= 0.21), and communication with nursing/ancillary staff (κ= 0.26). Attending and patient ratings of EM residents' communication skills show slight to fair agreement. The use of different types of raters may be beneficial in fully assessing trainees' communication skills.

Impact of satisfaction with physician\u2013patient communication on self-care and adherence in patients with hypertension: cross-sectional study

BackgroundHypertension (HT) requires patients to continuously monitor their blood pressure, strictly adhere to therapeutic recommendations, and self-manage their illness. A few studies indicate that physician–patient communication and the patient’s satisfaction with the therapeutic relationship may affect the course and outcomes of the treatment process. Research is still lacking on the association between satisfaction with physician–patient communication and adherence to treatment or self-care in chronically ill patients. The aim of the study was to evaluate the relationship between satisfaction with physician–patient communication and self-care and adherence in patients with HT undergoing chronic treatment.MethodsThe following instruments were used: the Adherence to Refills and Medication Scale (ARMS) for evaluating adherence (12–48 points), the Self-Care of Hypertension Inventory (SCHI) for self-care level (0–100 points), and the Communication Assessment Tool (CAT) for evaluating satisfaction with physician–patient communication. Socio-demographic and clinical data were obtained from patients’ medical records. The research has a cross-sectional and observational study design. Inclusion criteria were as follows: age > 18 years, hypertension diagnosed per European Society of Hypertension (ESH) guidelines, treatment with at least one antihypertensive drug for the past 6 months, and informed consent. Cognitively impaired patients unable to complete the surveys without assistance were excluded (MMSE ≤18). Correlations between quantitative variables were analyzed using Pearson’s or Spearman’s correlation coefficient. Linear regression was performed. Variable distribution normality was verified using the Shapiro-Wilk test.ResultsThe study included 250 patients (110 male, mean age 61.23 ± 14.34) with HT, treated at a hypertension clinic. In the CAT questionnaire individual questions pertaining to satisfaction with physician communication (on the CAT) were rated “excellent” 28.4–50.4% of the time. The best-rated aspects of communication included: letting the patient talk without interruptions (50.4% “excellent” ratings), speaking in a way the patient can understand (47.6%), and paying attention to the patient (47.2%). According to patient reports, physicians most commonly omitted such aspects as encouraging the patient to ask questions (28.4%), involving them in decisions (29.2%), and discussing the next steps (35.2%). The respondents had a low level of adherence to pharmaceutical treatment (16.63 ± 4.6). In terms of self-care, they scored highest in self-care management (64.17 ± 21.18), and lowest in self-care maintenance (56.73 ± 18.57). In correlation analysis, satisfaction with physician–patient communication (total CAT score) was positively correlated with all SCHI domains (self-care maintenance β = 0.276, self-care management β = 0.208, self-care confidence β = 0.286, p < 0.05), and negatively correlated with ARMS scores (indicating better adherence).ConclusionsSatisfaction with physician–patient communication has a significant impact on self-care and pharmaceutical adherence in patients with hypertension. The more satisfied the patient is with communication, the better their adherence and self-care.Trial registrationSIMPLE: RID.Z501.19.016.

Standardized Video Interview Scores Correlate Poorly with Faculty and Patient Ratings.

The Standardized Video Interview (SVI) was developed by the Association of American Medical Colleges to assess professionalism, communication, and interpersonal skills of residency applicants. How SVI scores compare with other measures of these competencies is unknown. The goal of this study was to determine whether there is a correlation between the SVI score and both faculty and patient ratings of these competencies in emergency medicine (EM) applicants. This was a retrospective analysis of a prospectively collected dataset of medical students. Students enrolled in the fourth-year EM clerkship at our institution and who applied to the EM residency Match were included. We collected faculty ratings of the students’ professionalism and patient care/communication abilities as well as patient ratings using the Communication Assessment Tool (CAT) from the clerkship evaluation forms. Following completion of the clerkship, students applying to EM were asked to voluntarily provide their SVI score to the study authors for research purposes. We compared SVI scores with the students’ faculty and patient scores using Spearman’s rank correlation. Of the 43 students from the EM clerkship who applied in EM during the 2017–2018 and 2018–2019 application cycles, 36 provided their SVI scores. All 36 had faculty evaluations and 32 had CAT scores available. We found that SVI scores did not correlate with faculty ratings of professionalism (rho = 0.09, p = 0.13), faculty assessment of patient care/communication (rho = 0.12, p = 0.04), or CAT scores (rho = 0.11, p = 0.06). Further studies are needed to validate the SVI and determine whether it is indeed a predictor of these competencies in residency.

A Multimodal Curriculum With Patient Feedback to Improve Medical Student Communication: Pilot Study.

IntroductionDespite the extraordinary amount of time physicians spend communicating with patients, dedicated education strategies on this topic are lacking. The objective of this study was to develop a multimodal curriculum including direct patient feedback and assess whether it improves communication skills as measured by the Communication Assessment Tool (CAT) in fourth-year medical students during an emergency medicine (EM) clerkship.MethodsThis was a prospective, randomized trial of fourth-year students in an EM clerkship at an academic medical center from 2016–2017. We developed a multimodal curriculum to teach communication skills consisting of 1) an asynchronous video on communication skills, and 2) direct patient feedback from the CAT, a 15-question tool with validity evidence in the emergency department setting. The intervention group received the curriculum at the clerkship midpoint. The control group received the curriculum at the clerkship’s end. We calculated proportions and odds ratios (OR) of students achieving maximum CAT score in the first and second half of the clerkship.ResultsA total of 64 students were enrolled: 37 in the control group and 27 in the intervention group. The percentage of students achieving the maximum CAT score was similar between groups during the first half (OR 0.70, p = 0.15). Following the intervention, students in the intervention group achieved a maximum score more often than the control group (OR 1.65, p = 0.008).ConclusionStudents exposed to the curriculum early had higher patient ratings on communication compared to the control group. A multimodal curriculum involving direct patient feedback may be an effective means of teaching communication skills.

Perception of medical communication skills during the clinical interview in a Peruvian teaching hospital: validation and application of an assessment tool

To determine the perception of patients regarding physicians communication skills at the outpatient clinic of a teaching hospital in Lima-Peru, using the Communication Assessment Tool (CAT). The study population was the group of patients treated in the outpatient clinics of the Cayetano Heredia Hospital. The CAT questionnaire contains 15 questions, and a version validated for Spanish was used. The perception of communication skills was defined as the sum of the scores of all the items, over the number of items, defined as: poor (1), fair (2), good (3), very good, (4), and excellent (5). The percentage of patients who rated communication skills as "poor" (average CAT Score) was 6.8%, "fair" 27.2%, "good" 23.9%, "very good" 30.1 and "excellent" 12.1%. Statistically significant differences were found when comparing the age ranges and among the different levels of education. The group of patients between 18 and 29 years old gave higher scores in the instrument (range 2.2 to 4.87, p = 0.001). Furthermore, when the educational level of the respondent was high, the participants tended to rate physicians with higher scores (range 3.67 to 4.73, p = 0.001). We found that 66.2% of patients had a positive perception of the physicians communication skills; only 12.1% rated it as "excellent," a value well below what is reported in the literature. Those who gave the best rating were younger patients with the highest level of education.

Translation and cultural adaptation of the Communication Assessment Tool (CAT), developing a Danish and Norwegian version.

To translate and cultural adapt the 14-item Communication Assessment Tool (CAT) into Norwegian and Danish, making them as similar as possible. This was a translation and validation study including individual interviews for content and face validity and a patient survey for internal consistency and floor-ceiling effect. Outpatient clinic at the Department of Internal Medicine, Lillebaelt Hospital, Denmark and a Norwegian general practice. Ten patients were included for individual interviews and 440 participants completed the survey. Translation and validation of the CAT. Despite minor differences in the use of words in the translated versions of CAT, the final versions were very similar. Based on the content and face validation and after agreement with the developers, it was decided to include a 'non-applicable' answering option, not a part of the original version. The use of 'non-applicable' for each item ranged from 0% to 30% in Norway and from 0% to 6.1% in Denmark. The overall CAT score, i.e. items rated excellent, were 55.5% in Norway and 50.3% in Denmark. For each item, the CAT score ranged between 31.3% and 69.8% in Norway and 33.7% and 57.4% in Denmark. The translated and validated CAT can be used to measure patients' perspectives on clinicians' communication skills in Denmark and Norway.

Patient Perspectives of Surgical Residents’ Communication: Do Skills Improve Over Time With a Communication Curriculum?

We aimed to assess surgical residents' communication confidence and skills, analyze resident feedback on our ongoing communication curriculum, and report feedback-driven updates. Surgical residents care for patients in the clinic and hospital and participate in a communication curriculum. We measure patient perception of resident communication using the Communication Assessment Tool (CAT). We assess resident skills confidence and collect curriculum feedback after each quarterly session. 900-bed tertiary care hospital with surgical residency program and simulation center. General surgery residents (PGY 1-5). We collected 353 CAT forms from patients in the clinic and hospital on 27 residents. Overall percent "excellent" scores (primary outcome) was 84%. In multivariate analysis we found a statistically significant increase in individuals' CAT scores over time at a rate of 1% improvement per month (p = 0.02). We observed significant improvement of skill confidence in 9 out of 10 training modules. Resident perception of the curriculum has improved over time with 90% of learners rating the course "A" or "A+" across all years. We updated the curriculum to be more learner-centered by: 1) providing differential scenarios for learner level; 2) engaging chief residents as co-faculty; 3) using both professional and volunteer (former patient) actors as SPs; and 4) refining the flow and timing of module practice. We assessed and analyzed surgical residents' communication skills and confidence over 17 months; both showed significant increase over the course of the communication curriculum. We adapted our curriculum using resident feedback and engagement. Our results suggest that communication training can be an effective tool to improve non-technical skills.

Provision of Parent Feedback via the Communication Assessment Tool: Does It Improve Resident Communication Skills?

ObjectiveTo determine the impact of a curriculum that included parent feedback, via the Communication Assessment Tool (CAT), on resident communication skills. MethodsIn a prospective, controlled study, categorical pediatric residents in continuity clinic were divided into control and intervention groups based on clinic day. Parent feedback was obtained for all residents at the beginning and end of the year using the CAT, a validated survey to assess physician communication. Intervention residents participated in learning conferences that reviewed communication best practices and received parental feedback via individual and group CAT scores. Scores were dichotomized as 5 (excellent) versus 1 to 4 (less than excellent) and reported as percentage of items rated excellent. Curriculum impact was assessed by comparing score changes between groups. Residents’ scores in both arms were combined to assess changes from the beginning of the year to the end. Statistical testing was performed using generalized linear mixed-effects models. ResultsAll residents (N = 68) participated. Intervention (n = 38) and control (n = 30) residents received at least 10 CATs at the beginning and end of the year. The percentage of parents rating all items as excellent increased by similar percentages in intervention and control groups (60.9%–73.8% vs 61.1%–69.8; P = .38). When scores of residents in both arms were combined, improvement was found from the beginning to the end of the year for all CAT items (P < .001). ConclusionsA curriculum including parent feedback from CATs did not significantly impact communication skills. However, communication skills improved over the year in intervention and control groups, suggesting that communication training occurs in multiple settings.

Evaluating Surgical Residents’ Patient-Centered Communication Skills: Practical Alternatives to the “Apprenticeship Model”

The Accreditation Council for Graduate Medical Education (ACGME) requires residency programs to assess communication skills and provide feedback to residents. We aimed to develop a feasible data collection process that generates objective clinical performance information to guide training activities, inform ACGME milestone evaluations, and validate assessment instruments. Residents care for patients in the surgical clinic and in the hospital, and participate in a communication curriculum providing practice with standardized patients (SPs). We measured perception of resident communication using the 14-item Communication Assessment Tool (CAT), collecting data from patients at the surgery clinic and surgical wards in the hospital, and from SP encounters during simulated training scenarios. We developed a handout of CAT example behaviors to guide patients completing the communication assessment. Independent academic medical center. General surgery residents. The primary outcome is the percentage of total items patients rated "excellent;" we collected data on 24 of 25 residents. Outpatient evaluations resulted in significantly higher scores (mean 84.5% vs. 68.6%, p < 0.001), and female patients provided nearly statistically significantly higher ratings (mean 85.2% vs. 76.7%, p = 0.084). In multivariate analysis, after controlling for patient gender, visit reason, and race, (1) residents' CAT scores from SPs in simulation were independently associated with communication assessments in their concurrent patient population (p = 0.017), and (2) receiving CAT example instructions was associated with a lower percentage of excellent ratings by 9.3% (p = 0.047). Our data collection process provides a model for obtaining meaningful information about resident communication proficiency. CAT evaluations of surgical residents by the inpatient population had not previously been described in the literature; our results provide important insight into relationships between the evaluations provided by inpatients, clinic patients, and SPs in simulation. Our example behaviors guide shows promise for addressing a common concern, minimizing ceiling effects when measuring physician-patient communication.

Communication During Pediatric Intensive Care Unit Family Conferences: A Pilot Study of Content, Communication, and Parent Perceptions

ABSTRACTWhile there is a robust literature describing family conferences (FCs) in adult intensive care units (ICUs), less information exists about FCs in pediatric ICUs (PICUs). We conducted a pilot study to describe the focus of discussion, communication patterns of health care team members (HTMs) and parents, and parents’ perspectives about clinician communication during PICU FCs. We analyzed data from 22 video- or audiorecorded PICU FCs and post-FC questionnaire responses from 27 parents involved in 18 FCs. We used the Roter Interaction Analysis System (RIAS) to describe FC dialogue content. Our questionnaire included the validated Communication Assessment Tool (CAT). FCs were focused on care planning (n = 5), decision making (n = 6), and updates (n = 11). Most speech came from HTMs (mean 85%; range, 65–94%). Most HTM utterances involved medical information. Most parent utterances involved asking for explanations. The mean overall CAT score was 4.62 (using a 1–5 scale where 5 represents excellent and 1 poor) with a mean of 73.02% “excellent” responses. Update and care-planning FCs had lower CAT scores compared to decision-making FCs. The lowest scoring CAT items were “Involved me in decisions as much as I wanted,” “Talked in terms I could understand,” and “Gave me as much information as I wanted.” These findings suggest that while health care providers spend most of their time during FCs relaying medical information, more attention should be directed at providing information in an understandable manner. More work is needed to improve communication when decision making is not the main focus of the FC.

361 Satisfaction With Provider Communication Is Associated With Perceived Disease Knowledge in Patients With Chronic Kidney Disease (CKD)

SATISFACTION WITH PROVIDER COMMUNICATION IS ASSOCIATED WITH PERCEIVED DISEASE KNOWLEDGE IN PATIENTS WITH CHRONIC KIDNEY DISEASE (CKD) Julie Wright, Kenneth Wallston, Svetlana Eden, Ayumi Shintani, T. Alp Ikizler, Kerri Cavanaugh. Vanderbilt University Medical Center, Nashville, TN USA Effective patient-provider communication is a crucial component of high quality patient care. Data are scarce regarding patient views of physician communication skills in the setting of pre-dialysis CKD care. Adult patients with non-dialysis dependent CKD (Stages 1-5) were enrolled from April-October 2009 during nephrology clinic visits. Patient satisfaction with provider communication was assessed using the Communication Assessment Tool (CAT), a validated scale for measuring patient perception of physician interpersonal and communication skills. Perceived knowledge was assessed by asking patients to rate their CKD knowledge on a scale from 1 (no knowledge) to 4 (a lot of knowledge) in nine areas and averaged to generate an overall perceived knowledge survey (PiKS) score. Associations between CAT and patient characteristics, including PiKS and a validated measure of objective CKD knowledge, were examined. Of 399 patients enrolled, the mean (SD) age was 57 (16) years. 53% were male, 83% Caucasian, and 77% had CKD Stage 3-5. The mean (SD) CAT and PiKS scores were 4.69 (0.51) and 2.56 (0.61), respectively. CAT was associated only with PiKS (Spearman correlation 0.15, p<0.0001) in unadjusted analysis. Patients of older age (OR 1.22 CI [1.11, 1.35]; p<0.0001 per 10 years), higher eGFR (1.03 [1.02, 1.04]; p<0.0001 per 5 ml/min/1.73m), and higher PiKS (2.15 [1.72, 2.68]; p<0.0001 per 1.0 increment increase) were likely to have higher odds of satisfaction with provider communication in adjusted analysis that also included sex, race, health literacy (REALM survey), income, number of provider visits, and objective knowledge. Adjusted analysis presented no evidence that objective knowledge was associated with CAT score. In addition to advancing age and higher eGFR, patients' perception of their disease specific knowledge may be an important component of their satisfaction with CKD care.