Resident Communication Skills Research Articles

Capturing the patients’ voices: Planning for patient-centered electronic health record use

ObjectivesTo understand (1) the perceptions of patients regarding use of EHR during clinic visits, (2) the impact of the presence of EHR on patient interactions with physicians, and (3) the ways in which EHR usage might increase patient engagement. MethodsWe conducted semi-structured interviews of a convenience sample of patients of internal medicine resident doctors from three primary care clinics. Interviews were audio-recorded and transcribed verbatim. We used thematic analysis to identify themes from the transcripts. Informed consent was obtained from each participant. ResultsWe interviewed 32 patients; 37.5% male. Our analysis revealed three primary themes: (1) the views and beliefs of patients on the use of EHR in clinics, (2) patients’ perception of the communication skills of residents, and (3) patients’ perceptions about information sharing, patient engagement, and health education related to the EHR. An invitation to patients to view the screen as the physician interprets its content increases patient satisfaction and understanding. Residents’ possessed skills in communication is not impeded when using EHR. ConclusionPatients generally express a positive or neutral perception of EHR use during clinic visits. Using information voiced by patients, we can teach health providers EHR strategies that are likely to engage patients in the visit and engender their trust.

Improving Resident Communication Skills With Patients of Diverse Backgrounds

Improving Resident Communication Skills With Patients of Diverse Backgrounds

Appraisal of the communication skills of residents in the Family Medicine Program in Central Saudi Arabia.

Objectives:To assess patients’ perceptions of the communication skills of family medicine residents.Methods:This is a cross-sectional study. Data were collected from patients, seeing 23 residents from 4 family medicine residency programs in Riyadh, Kingdom of Saudi Arabia namely, King Khalid University Hospital, Riyadh Military Hospital, Security Forces Hospital, and King Abdul-Aziz Medical City. The translated version of the Communication Assessment Tool (CAT) was used. Data were collected during January and February 2013.Results:A total of 350 patients completed the CAT, with an 87.5% response rate. Patients rated each resident differently, but the mean percentage of items, which residents rated as excellent was 71%. In general, male residents were rated higher 72.8 ± 27.2 than female residents 67.8 ± 32.2 with a significant difference; (p<0.005). Also, significant differences were found based on the gender of the residents, when each item of the CAT was compared. Comparing training centers, there were no significant differences found in the overall percentage of items rated as excellent or among items of the CAT.Conclusion:The study identified areas of strength and weaknesses that need to be addressed to improve communication skills of physicians.

Communication skills of tutors and family medicine physician residents in Primary Care clinics

AimTo determine the communicative profiles of family physicians and the characteristics associated with an improved level of communication with the patient. DesignA descriptive multicentre study. LocationPrimary Healthcare Centres in Almeria, Granada, Jaen and Huelva. Participants119 family physicians (tutors and 4th year resident physicians) filmed and observed with patients.Principal measurements: Demographic and professional characteristics. Analysis of the communication between physicians and patients, using a CICAA (Connect, Identify, Understand, Agree and Assist, in English) scale. A descriptive, bivariate, multiple linear regression analysis was performed. ResultsThere were 436 valid interviews. Almost 100% of physicians were polite and friendly, facilitating a dialogue with the patient and allowing them to express their doubts. However, few physicians attempted to explore the state of mind of the patient, or enquire about their family situation or any important stressful events, nor did they ask open questions. Furthermore, few physicians summarised the information gathered. The mean score was 21.43±5.91 points (maximum 58). There were no differences in the total score between gender, city, or type of centre. The linear regression verified that the highest scores were obtained from tutors (B: 2.98), from the duration of the consultations (B: 0.63), and from the age of the professionals (B: −0.1). ConclusionPhysicians excel in terms of creating a friendly environment, possessing good listening skills, and providing the patient with information. However the ability to empathise, exploring the psychosocial sphere, carrying out shared decision-making, and asking open questions must be improved. Being a tutor, devoting more time to consultations, and being younger, results in a significant improvement in communication with the patient.

Depression Training in an Assisted Living Facility: A Pilot Study.

Depression in older adults residing in assisted living facilities (ALFs) is often not recognized. ALF staff who work with residents on a daily basis are the most likely individuals to recognize residents' depressive symptoms. The purpose of the current pilot study was to determine feasibility of a 4-week training program for 15 direct care staff to recognize any depression symptoms of 32 residents. Although training significantly improved knowledge, it did not improve staff recognition of residents with positive depressive symptoms. Staff reported the training provided them a better understanding about depression and rated the training as very helpful to be able to recognize depression symptoms. Staff requested more information on ways to respond to someone who is depressed. Additional training should emphasize staff-resident communication skills for staff. Challenges included resident attrition and dwindling staff participation. Strategies to address these challenges are presented. [Journal of Psychosocial Nursing and Mental Health Services, 54(5), 25-31.].

The Impact of a Resident Communication Skills Curriculum on Patients’ Experiences of Care

Despite the high impact of lapses in communication skills on patient care, these skills are often not explicitly taught in residency training programs. We implemented a simulation and web-based curriculum in communication for anesthesia residents and used a patient survey adapted from the Four Habits Coding Scheme to detect changes in patient feedback on residents' communication skills after the curricular intervention. Postintervention mean ratings of residents for the overall survey were higher than preintervention mean ratings. Future research will focus on assessing the curriculum's effectiveness and exploring the generalizability of the survey and curriculum.

A Curriculum to Enhance Resident Communication Skills During Family Conferences in the Intensive Care Unit

Abstract Introduction As part of a hospital-wide initiative to improve patient-physician communication, we developed a curriculum on the facilitation of family conferences in the medical intensive ...

Teaching Surgery Residents the Skills to Communicate Difficult News to Patient and Family Members: A Literature Review.

Trainees and practicing physicians alike find breaking bad, sad, or difficult news to a patient or family member as one of the most challenging communication tasks they perform. Interpersonal and communication skills are a core competency for resident training. However, in disciplines where technical skills have a major emphasis, such as surgery, the teaching of communication skills may not be a priority. The objective of our study is to review literature in order to identify best practices and learning modalities used to teach surgery trainees the communication skills regarding delivery of difficult news to patients and family members. The criteria for inclusion in this literature review were that the study (1) addresses surgeons' training (nontechnical skills) in breaking difficult news to patient and/or families, (2) describes a teaching modality or intervention targeted to teach surgery residents how to deliver difficult news to patient/family, and (3) is published in English. Articles (n = 225) were screened for final eligibility. After discarding duplicates and noneligible studies, and after abstract/full-text review, 18 articles were included in the final analysis. Most studies are single site; address general surgery residents at varying training levels; and include case-specific, outpatient, and intensive care unit (ICU) settings. There is a paucity of studies in the trauma and unexpected death setting. There is a recent trend to use Objective Structured Clinical Examination (OSCE) both to teach and assess communication skills. Variable tools are used to assess this competency as described. Simulation and OSCE format have emerged as modalities of choice both to teach surgery residents how to deliver difficult news and to assess achievement of this competency. There is a gap in the literature regarding teaching and assessing surgery resident communication skills in delivering difficult news after unexpected events in the trauma and operating room settings.

Resident Ratings of Communication Skills Using the Kalamazoo Adapted Checklist.

The Kalamazoo Essential Elements Communication Checklist-Adapted (KEECC-A) is a well-regarded instrument for evaluating communication and interpersonal skills. To date, little research has been conducted that assesses the accuracy of resident self-ratings of their communication skills. To assess whether residents can accurately self-rate communication skills, using the KEECC-A, during an objective structured clinical examination (OSCE). A group of 104 residents from 8 specialties completed a multistation OSCE as part of an institutional communication skills curriculum conducted at a single institution. Standardized patients (SPs) and observers were trained in rating communication skills using the KEECC-A. Standardized patient ratings and resident self-ratings were completed immediately following each OSCE encounter, and trained observers rated archived videotapes of the encounters. Resident self-ratings and SP ratings using the KEECC-A were significantly correlated (r104 = 0.238, P = .02), as were resident self-ratings and observer ratings (r104 = 0.284, P = .004). The correlation between the SP ratings and observer (r104 = 0.378, P = .001) ratings were larger in magnitude, but not significantly different (P > .05) from resident/SP or resident/observer correlations. The results suggest that residents, with a modicum of training using the KEECC-A, can accurately rate their own communication and interpersonal skills during an OSCE. Using trained observers to rate resident communication skills provides a unique opportunity for evaluating SP and resident self-ratings. Our findings also lend further support for the reliability and validity of the KEECC-A.

Adolescent Contraception Knowledge and Relationship to Resident Communication Skills

Adolescent Contraception Knowledge and Relationship to Resident Communication Skills

Standardized patient-based assessment of dermatology resident communication and interpersonal skills.

Standardized patient-based assessment of dermatology resident communication and interpersonal skills.

74. Pediatric Resident Interpersonal/Communication Skills: Do They Play a Role in Adolescent Contraception Knowledge After a Clinic Visit?

One focus of resident education in adolescent medicine is contraception and it is difficult to assess how effective this education is on patient knowledge. Competencies, including interpersonal and communication skills, and evaluation continue to be a focus of the American Board of Pediatrics and Accreditation Council on Graduate Medical Education. There is no literature assessing real-time education and communication between residents and patients regarding contraception. The purpose of this study was to (a) assess patient's learned contraception knowledge, (b) assess resident-provided contraception education, (c) assess resident interpersonal/communication skills, and (d) determine which factors result in increased patient contraception knowledge. In this IRB approved study, resident physicians (n=19) and adolescent girls aged 14-21 years (n=33) were recruited from an urban primary care clinic to complete surveys regarding demographics, contraception knowledge and education, and resident communication skills. Data were analyzed using descriptive statistics for adolescent- and resident-level factors. Bivariate analyses were utilized to determine potential association between adolescent- and resident-level factors and patient contraception knowledge (SPSS 21.0). 82% of the adolescents were Black/African-American. Patients chose OCPs (n=17) and Depo-Provera (n=14) as their form of contraception. For OCP group, 41% of the patients knew what to do if pills were missed, 12% recognized OCP association with cancer, and 48% knew OCP relationship to getting pregnant after pill discontinuation. For Depo-Provera group, 29% knew relationship to bone health and 43% recognized Depo-Provera relationship to getting pregnant after injection discontinuation. The scale for percentage of resident-patient visit spent on contraception education was found to have a reliability statistic of 0.88 for OCP, 0.74 for Depo-Provera. For OCP group, 56% of the residents did not discuss relationship to cancer; 50% did not discuss relationship to getting pregnant after stopping OCP. For Depo-Provera group, 64% of residents did not discuss relationship to getting pregnant after injection discontinuation. The scale for resident interpersonal/communication skills was found to have a reliability statistic of 0.95. 64-79% of the residents were rated perfectly for their interpersonal/communication skill items, but 51.5% of residents were less than perfect at discussing confidentiality. Bivariate analyses were marginally significant for resident week of rotation and OCP (d=0.61), birth control counseling and OCP (d=0.67), and history of sexual education and Depo-Provera (d=0.69). This suggests these factors may be important predictors in larger studies. Despite resident report of education provided, patient contraception knowledge is lacking regarding relationship between stopping contraception and getting pregnant, OCP and cancer, OCP and missed doses, and Depo-Provera and bone health. Adolescents reliably assess resident interpersonal/communication skills but felt residents did not discuss confidentiality perfectly compared to other skills. Promising factors that may lead to increased contraception knowledge include increased resident week of rotation, resident history of birth control counseling in continuity clinic, and patient history of sexual education.

Applying Clinical Research Skills to Conduct Education Research: Important Recommendations for Success.

Imagine a physician who wants to research options to help her patients lose weight. As a clinical researcher, she may first explore the efficacy of a medication. Not only is there an instrument that accurately collects patient weight but also the link between the intervention (medication) and the outcome (weight) has been established. Her study manipulates the behavior of the physician (what should be prescribed), and the intervention is administered to the patient, who in this case, is a relatively passive recipient.

Board #250 - Program Innovation Training Residents to Measure Intra-Abdominal Pressure Using Simulation

Objectives Intra-abdominal hypertension (IAH) and abdominal compartment syndrome (ACS) have been associated with patient morbidity and mortality, reported to occur in 20% to 40% of critically ill patients.1 This high-incidence rate and high risk make monitoring of intra-abdominal pressure (IAP) through pressure measurements an important element in care of at-risk patients.2 In most hospitals, nursing personnel are responsible for IAP measurements, often reporting these to a resident. Nursing personnel are generally educated on IAP measurements by vendors of the measuring device. Conversely, residents have historically had very little instruction on measurement of IAP, yet are called upon to substantiate these measurements and to form clinical action plans based upon the measurements. This disconnect was approached through an innovative educational session using simulation. To provide residents more experience in measurement skills, a safe simulated environment was chosen. Objectives of the simulation were to: 1) teach residents the correct method for measuring IAP, 2) help residents identify common pitfalls in abdominal pressure measurements, 3) Identify the factors that may give false readings, 4) improve resident communication skills. Description A scenario using high-fidelity simulation was developed to teach residents how to correctly measure IAP and identify common pitfalls often leading to inaccurate readings. The scenario centered around a critically ill patient with pancreatitis. The patient (a high-fidelity simulator) was sitting upright, under mechanical ventilation, and was reported to be fighting the ventilator. An indirect measurement of IAP was determined using an bladder pressure monitoring device. A designated RN from the intensive care unit served as a confederate in all of the scenarios. Residents were individually introduced to a scenario involving a reported elevated IAP, and were expected to assess the patient and address the reported elevated IAP. Four major pitfalls were included in the scenario: 1) patient positioning, 2) lack of paralyzing agent, 3) transducer not leveled, 4) an aberrant clamp on the bladder catheter. Following the simulation, residents were individually debriefed and were provided feedback by experienced physicians who observed the scenario. Conclusion Overall, the training session was successful as assessed by both learners and faculty. It was simple to run, consistent throughout and efficient, allowing for multiple residents to complete training in limited time. The outcomes from the training gave a dependable baseline, making this an ideal method to use in observing resident skills in intra-abdominal pressure measurement, including diagnosis, trouble shooting, and interpretation of IAP readings. Residents were provided learning through hands-on application in the scenario and immediate feedback regarding their individual performance. Additional key findings of the simulation training: 1) debriefing the residents individually to provide formative feedback was a key factor in the learning process, 2) the less experienced residents struggled more in the simulation where as more senior residents were more likely to make an appropriate evaluation and diagnosis, 3) having a consistent nurse confederate was felt to be helpful in creating more realism and helping to steer the residents toward the correct measurement and diagnosis.

Measuring General Surgery Residents’ Communication Skills From the Patient’s Perspective Using the Communication Assessment Tool (CAT)

The Communication Assessment Tool (CAT) has been used and validated to assess Family and Emergency Medicine resident communication skills from the patient's perspective. However, it has not been previously reported as an outcome measure for general surgery residents. The purpose of this study is to establish initial benchmarking data for the use of the CAT as an evaluation tool in an osteopathic general surgery residency program. Results are analyzed quarterly and used by the program director to provide meaningful feedback and targeted goal setting for residents to demonstrate progressive achievement of interpersonal and communication skills with patients. The 14-item paper version of the CAT (developed by Makoul et al. for residency programs) asks patients to anonymously rate surgery residents on discrete communication skills using a 5-point rating scale immediately after the clinical encounter. Results are reported as the percentage of items rated as "excellent" (5) by the patient. The setting is a hospital-affiliated ambulatory urban surgery office staffed by the residency program. Participants are representative of adult patients of both sexes across all ages with diverse ethnic backgrounds. They include preoperative and postoperative patients, as well as those needing diagnostic testing and follow-up. Data have been collected on 17 general surgery residents from a single residency program representing 5 postgraduate year levels and 448 patient encounters since March 2012. The reliability (Cronbach α) of the tool for surgery residents was 0.98. The overall mean percentage of items rated as excellent was 70% (standard deviations = 42%), with a median of 100%. The CAT is a useful tool for measuring 1 facet of resident communication skills-the patient's perception of the physician-patient encounter. The tool provides a unique and personalized outcome measure for identifying communication strengths and improvement opportunities, allowing residents to receive specific feedback and mentoring by program directors.

What are internal medicine residents missing? A communication needs assessment of outpatient clinical encounters

ObjectiveIn order to guide curricular innovation, we looked at the feasibility and utility of performing a targeted needs assessment of the communication skills of PGY2 internal medicine (IM) residents in their continuity clinic, utilizing faculty direct observation with a validated instrument for communication skills evaluation. MethodsA convenience sample of PGY2 residents in the Emory University School of Medicine IM Residency Program was invited to participate. Using the SEGUE Framework, a checklist of medical communication tasks, faculty assessed residents during a clinic encounter. ResultsThirty out of 53 (57%) PGY2 residents were assessed. SEGUE results indicate residents were most likely to “maintain patient's privacy” (100%), “greet patient appropriately” (97%) and “check/clarify information” (100%). Residents were least likely to “acknowledge waiting time” (7%), “explore psychosocial/emotional factors” (27%) and “outline agenda for visit” (33%). ConclusionThe SEGUE Framework is a feasible tool to evaluate the communication skills of IM residents in a clinic setting. Many PGY2 IM residents in a large, urban practice do not elicit important psychosocial information during outpatient clinic visits. Practice implicationsMore observation and evaluation of residents’ communication skills are needed, with emphasis on building skills to “Understand the Patient's Perspective.”

Training obstetrics and gynecology residents to be effective communicators in the era of the 80-hour workweek: a pilot study.

BackgroundTo ensure optimal patient care, physicians must establish effective patient-physician relationships and thoughtfully incorporate their patients’ perspectives into their counseling. Historically, these skills are acquired with increasing clinical experience. However, given increasing work-hour restrictions, OB/GYN residents have fewer opportunities to develop these skills. Therefore, the objective of this study was to determine if an interactive learning method is an effective tool by which to teach OB/GYN residents how to communicate with complicated patients.MethodsAn experiential simulation model was developed to teach OB/GYN residents effective communication skills for dealing with patients experiencing a pregnancy-related complication. A simulated patient interaction was designed for first-year residents. Specific scenarios were constructed based on challenging clinical scenarios identified by second-year residents. Non-judgmental communication, culture competency awareness and reflective listening were key skills that were taught as part of the clinical scenarios. Both acceptability and utility of the exercise with the first-years was assessed by a follow-up survey.ResultsSeven first-year residents participated in the education session consisting of four physician-patient interactions with specific learning objectives for each. These first-year residents all indicated that they would employ the skills practiced during the intervention into their future practice of medicine, and that their comfort level in caring for complex obstetric patients had increased. Moreover, all first-year residents endorsed that this educational strategy was potentially applicable to other aspects of their training.ConclusionsSimulated patient exercises can be utilized in multiple arenas to teach OB/GYN residents communication skills, while simultaneously addressing their clinical knowledge deficits. Early implementation of such a curriculum in an OB/GYN residency will lay the foundation for the development of empathetic and culturally competent physicians.

Let’s Give Them Something to Talk About: Assessment of Communication Skills in Pediatric Residents

Let’s Give Them Something to Talk About: Assessment of Communication Skills in Pediatric Residents

Assessing Interpersonal and Communication Skills in Radiation Oncology Residents: A Pilot Standardized Patient Program

There is a lack of data for the structured development and evaluation of communication skills in radiation oncology residency training programs. Effective communication skills are increasingly emphasized by the Accreditation Council for Graduate Medical Education and are critical for a successful clinical practice. We present the design of a novel, pilot standardized patient (SP) program and the evaluation of communication skills among radiation oncology residents. Two case scenarios were developed to challenge residents in the delivery of "bad news" to patients: one scenario regarding treatment failure and the other regarding change in treatment plan. Eleven radiation oncology residents paired with 6 faculty participated in this pilot program. Each encounter was scored by the SPs, observing faculty, and residents themselves based on the Kalamazoo guidelines. Overall resident performance ratings were "good" to "excellent," with faculty assigning statistically significant higher scores and residents assigning lower scores. We found inconsistent inter rater agreement among faculty, residents, and SPs. SP feedback was also valuable in identifying areas of improvement, including more collaborative decision making and less use of medical jargon. The program was well received by residents and faculty and regarded as a valuable educational experience that could be used as an annual feedback tool. Poor inter rater agreement suggests a need for residents and faculty physicians to better calibrate their evaluations to true patient perceptions. High scores from faculty members substantiate the concern that resident evaluations are generally positive and nondiscriminating. Faculty should be encouraged to provide honest and critical feedback to hone residents' interpersonal skills.

Standardized Teamwork Training Improves Trauma Workflow

Multiple studies suggest teamwork deficiencies contribute to suboptimal outcomes in trauma care. Surgical residents often play crucial roles in trauma management in academic centers despite limited experience leading multidisciplinary teams and variable rotations through the trauma service. We hypothesized 1) that improving the teamwork and communication skills of residents would improve trauma care and 2) that time limited and focused team training could achieve this goal.