Physician Communication Skills Research Articles

Attitudes and Confidence in Communication Skills of Fourth-Year Medical Students After Online Small Group Discussion and Peer Role-Play: A Survey Study.

This study investigated the impact of online small group discussions and peer role-play on medical students' attitudes toward and confidence in communication skills. The study involved a 3-hour instructional design that integrated small group discussions and role-plays to enhance the communication abilities of fourth-year medical students. The data were obtained from students through a post-activity online survey. Likert scale responses were quantified as percentages. Students' narrative feedback on their learning achievements was subjected to content analysis. Codes and categories were agreed upon by investigators and reviewed by an external auditor. A total of 151 medical students responded to the survey, representing a 47.94% response rate. The majority strongly agreed that good communication skills help physicians obtain reliable information (94.00%) and that practicing questioning skills is essential (92.1%). Content analysis revealed that nearly half (48.34%) considered that the learning activities fostered positive attitudes toward communication. These attitudinal improvements included increased empathy and emotional care (37.75%), recognition of communication as a trainable skill (10.57%), and recognition of the necessity of communication skills for physicians (8.61%). Additionally, most students (75.5%) reported increased confidence in their communication skills. In alignment with transformative learning theory, online small group discussions combined with peer role-play may potentially enhance the attitudes and confidence of medical students in relation to communication skills.

Mediating role of physician's empathy between physician's communication and patient's satisfaction.

Physician communication is vital for an effective physician-patient relationship. Physician empathy is crucial to patient communication. The relationship between physician empathy, physician communication, and patient satisfaction is not very clear. This study aims to study the mediating role of physician's empathy between physician's communication, physician's empathy, and patient's satisfaction. A cross-sectional study was conducted at the National Institute of Psychology, Quaid-i-Azam University, during the time period of December 2018 to February 2019. Employing the technique of purposive convenience sampling, data were collected (N = 238) from psychiatric, cardiology, and dermatology wards of public and private sector hospitals of Islamabad and Rawalpindi. The Communication Assessment Tool, specifically the Patient's Perception of Physician's Empathy and Patient Satisfaction Scale, was used to assess study variables. The measures used in the research assess the patient's perception of the physician's communication, empathy, and patient's satisfaction. Formal permission for the research was taken from the hospital administration with approval from the institutional review boards. Participants were briefed about the purpose of the research. Both verbal and written informed consent was taken from them. The result shows that a physician's empathy plays a mediating role between the physician's communication skills and patient satisfaction. Moreover, Pearson product-moment correlation indicated a significant positive relationship between doctors' communication skills, doctors' empathy, and patients' satisfaction. Building a positive doctor-patient relationship would not only lead to improved patient satisfaction but also reduce the likelihood of medical malpractice. Therefore, steps should be taken to enforce trust, interaction, and empathy in doctor-patient relationships, with patient-centered services. Physician's empathy plays a mediating role between physician's communication skills and patient's satisfaction.

Simulating empathy: A qualitative experiential study of embedded resident learners in an empathy curriculum.

Physician empathy and communication skills are crucial parts of a successful emergency department (ED) interaction. This study aimed to evaluate whether these skills can be improved through a novel curriculum where interns act as patients for their senior residents during simulated ED cases. Twenty-five residents participated in the curriculum. Prior to the cases, participants filled out the Toronto Empathy Questionnaire (TEQ). They then completed three simulated cases, with the 11 interns portraying the patients and the 14 seniors (postgraduate year [PGY]-2 and PGY-3 residents) in the physician role. Following the cases, the residents participated in a recorded, structured focus group. At the conclusion of the session participants again filled out the TEQ and answered a Likert questionnaire on their thoughts about the curriculum. Qualitative analysis was used to determine themes from the debriefs. Twenty-two residents completed all components of the study. The mean (±SD) TEQ scores pre- and postcurriculum for all residents were 46.2 (±4.64) pre and 47.9 (±6.03) post (ns). On qualitative analysis, we derived four major themes: empathy, communication, feedback, and physician experience. The most common subthemes discussed were empathy for the patient situation and the importance of communicating visit expectations. On a 5-point Likert survey related to the simulated cases, respondents rated comfort providing feedback to their peers (mean ± SD 4.41 ± 0.95) and gaining insight into the patient experience (mean ± SD 4.27 ± 0.83). The embedded intern exercise was rated well by resident participants, with no observed change in empathy scores. Qualitative analysis identified empathy and communication as major themes. Residents enjoyed this style of simulation and found it realistic.

Application of the combination of CBL teaching method and SEGUE framework to improve the doctor-patient communication skills of resident physicians in otolaryngology department

BackgroundTo explore the feasibility and effectiveness of applying CBL teaching method and SEGUE Framework in the doctor-patient communication skills of resident physicians in the department of otolaryngology.MethodsThis is an observational study to compare the score changes in doctor-patient communication skills of 120 resident physicians, before and after using CBL combined SEGUE Framework teaching method. The effects of gender, age, grade, educational background and marital status on SEGUE score were analyzed.ResultsThrough the combined application of CBL teaching method and SEGUE Framework, the SEGUE score of 120 resident physicians was significantly improved. There was no significant difference in SEGUE score among different sex and marital status of resident physicians. SEGUE score is positively correlated with age; Different grades and educational backgrounds have significant effects on SEGUE score.ConclusionThe combination of CBL teaching method and SEGUE Framework is feasible and effective in the education program of doctor-patient communication skills for resident physicians in the department of otolaryngology, and worthy of popularization and application in other medical specialties.

Evaluation of communication skills of physicians working in a training and research hospital: A cross-sectional study

Communication; is a two-way process of reaching mutual understanding in which information is exchanged, produced and interpreted. The main component of the diagnosis and treatment process between patient and physician is communication. In this study, we aimed to evaluate the communication skills of physicians according to various variables. The cross-sectional and descriptive study was conducted with physicians working at Haydarpaşa Numune Training and Research Hospital (HNH TRH) between May and August 2012. A total of 156 physicians who completed the scales and personal information form and met the inclusion criteria constituted the sample of the study. A total of 156 physicians with a mean age of 31.73±5.88 years participated in the study. Seventy-nine (50.6%) of the physicians reported that they could not devote enough time to themselves and their families, 118 (75.6%) physicians reported that they had communication problems with their patients in the past year, and only 56 physicians (35.9%) found themselves productive in their jobs. Sixty-five physicians (41.7%) felt exhausted, 116 (74.4%) of them reported that the reason for the communication problems they had was lack of time. There was a weak positive correlation between age and overall assessment of communication skills (p<0.05). There was a positive and weak correlation between age and mental and emotional communication skills (p<0.01). Limited time and low economic income negatively affect communication skills. Lowering patient density in hospitals and giving sufficient importance to primary health care services are needed. Focusing on communication skills training in medical schools and continuing this education throughout professional life can have positive effects on the patient-physician relationship.

Physicians’ attention to patients’ communication cues can improve patient satisfaction with care and perception of physicians’ empathy

The pathway that links good communication skills and better health outcomes is still unclear. However, it is known that the way that physicians and patients communicate with each other has direct consequences on more "proximal outcomes", such as perceptions of physician empathy and patient satisfaction. However, which specific communication skills lead to those patient outcomes is still unknown. In this study, the authors aimed to analyze which specific patient and physician communication skills are correlated to patients' satisfaction with care and patient-perceived physician empathy. The authors classified and quantified verbal and nonverbal communication of second-year internal medicine residents and their patients through video recordings of their consultations. Patients also rated their satisfaction with care and the physician's empathy for them. Using a linear regression model, the authors identified that patients' and physicians' expressions of disapproval, physicians' disruptions, and patients' use of content questions negatively correlated to patients' satisfaction and patient-perceived physician empathy. Conversely, patient affective behaviors and the physician's provision of advice/suggestion were positively correlated to at least one of the patient-measured outcomes. Our findings point to the importance of physicians' attentiveness to patients' communication cues. Training physicians to interpret those cues could help develop more satisfactory and empathic therapeutic relationships.

Visual Intelligence Education as a Tool for Enhancing Medical Students' Self-Perception of Communication Skills.

Visual arts-based exposure and training are effective tools to enhance medical education. The visual arts can increase emotional intelligence and critical thinking skills. This study, conducted at Georgetown University School of Medicine (GUSoM) and the National Gallery of Art (NGA) in Washington, DC, was designed to measure the effect of a visual arts elective course on medical students' self-perception of their communication skills. This 6-week course involved lessons at the NGA and GUSoM for16 second-year medical students. The intervention students were age and gender-matched to14 second-year medical student control participants who took different elective courses. Prior to and following the intervention, the participants completed the Communication Skills Attitude Scale (CSAS). Statistical analysis was performed with either the 2-sided t-test or 2-sided Wilcoxon rank-sum test. There were no statistically significant differences in the presurvey scores between the groups. However, there were 6 CSAS questions in the postsurveys that had statistically significant differences between the 2 groups. Within each group, there were also numerous statistically significant differences between their presurvey and postsurvey responses, with positive changes occurring in the intervention group (IG) and primarily negative changes occurring in the control group (CG). The NGA course improved the self-perception of communication skills, with students reporting stronger views on the importance of communication skills in teamwork and patient rapport. The CG, on the other hand, did not have as many improved perceptions of communication skills and had stronger opinions regarding not needing the ability to communicate well to be a good physician. This study indicates that medical student communication skills can benefit from exposure to visual arts activities and experiences. Future physicians must become effective communicators, and this study paves the way for research investigating the relationship between visual arts education and the development of a physician's communication skills.

Virtual reality evidence on the impact of physicians' open versus defensive communication on patients.

Using virtual reality (VR) in an experimental setting, we analyse how communicating more openly about a medical incident influences patients' feelings and behavioural intentions. Using VR headsets, participants were immersed in an actual hospital room where they were told by a physician that a medical incident had occurred. In a given scenario, half of the participants were confronted by a physician who communicated openly about the medical incident, while the other half were confronted with the exact same scenario except that the physician employed a very defensive communication strategy. The employed technology allowed us to keep everything else in the environment constant. Participants exposed to open disclosure were significantly more likely to take further steps (such as contacting a lawyer to discuss options and filing a complaint against the hospital) and express more feelings of blame against the physician. At the same time, these participants rated the physician's communication skills and general impression more highly than those who were confronted with a defensive physician. Nevertheless, communicating openly about the medical incident does not affect trust in the physician and his competence, perceived incident severity and likelihood of changing physician and filing suit.

Facilitators and barriers in the donor family interview process from the perspective of hospital staff: a cross-sectional study.

Obtaining consent from potential donor families is a challenging step in the donation process and is influenced by various factors. In this cross-sectional study, we utilized a questionnaire containing 14 questions about facilitators and barriers in the family interview process. The questionnaire was distributed in March 2023 to intensive care unit (ICU) nurses who had experience with donor family interviews. We collected the opinions of these respondents on hospital performance and drew comparisons between the studied hospitals. A total of 60 participating ICU nurses provided mean scores for hospital performance in family interviews of 2.60±0.84 for type I hospitals (those providing neurosurgery and trauma care) and 2.035±0.890 for type II hospitals (those without neurosurgery and trauma services; P=0.04). The mean scores for public and private hospitals were 1.86±0.86 and 2.59±0.85, respectively (P=0.008). Based on the findings, the most important facilitators were the availability of organ donation staff and access to a professional team for family discussions. Conversely, poor physician communication skills and limited communication capabilities among medical staff were identified as significant barriers. Implementation of a professional team for family interviews was found to be more critical for type II hospitals. Poor physician communication skills were a significant concern in public hospitals, while families' lack of awareness of patient prognosis emerged as a key barrier in private hospitals. This study highlights numerous facilitators and barriers that vary across hospitals. Addressing these issues individually and developing tailored plans to enhance hospital performance in interviewing donor families is essential.

Assessing Levels of Empathy among Undergraduate Medical Students: Results of a Cross-Sectional Study Conducted in a Medical College in Sohar, Oman

OBJECTIVE: Empathy is an essential aspect of communication skills for physicians, especially primary care physicians. The study aims to explore the empathy scores among medical students at different stages of medical training and to analyze the effect of gender and career choice on the empathy scores of medical students. METHODOLOGY: A cross-sectional study was conducted from October 2021 to January 2022 in a medical college in Sohar, Oman. All the students were eligible to participate in this study. Simple random sampling was employed, and participants were administered a 20-item Jefferson Scale of Empathy-Student (JSE-S) Version. Data were analyzed using SPSS version 22. Mean and standard deviation were reported for continuous variables. Subgroup comparisons were conducted using t-test and ANOVA. RESULTS: Out of 424 participants, the majority were female (n=390,92%), and over half of the students (56%) were less than 22 years of age. The mean empathy score of students on the JSE-S scale was 104.6 ± 17.43 (range: 37-140). Subgroup analysis revealed that males had a slightly high score on JSE-S (male: 105.7+14.56, female: 104.5+17.6, p-0.23). Empathy scores showed an increasing trend as the student progressed through medical school (6th year: 106.2+16.16). Empathy scores were almost similar for students who had preferred people or procedure-oriented fields as their career pathway (p-0.59). CONCLUSION: The study reflects the need to include empathy in teaching communication skills to medical students as an integral part of the medical school curriculum, which could assist them in becoming compassionate physicians and increasing patient satisfaction. KEYWORDS: Empathy, empathy scores, JSPE, Medical Students, Physicians, Undergraduate Medical Students.

CURRENT ASPECTS OF ENGAGING PATIENTS TO SHARED DECISION-MAKING AND PARTNER PARTICIPATION IN THE TREATMENT PROCESS (review)

The aim of the research: to conduct an analysis and generalization of scientific publications on the engaging patients to shared decision-making and partner participation in the treatment process.
 Materials and methods. The analysis and generalization of scientific publications on the implementation of shared decision-making strategy and the engaging of patients to self-management and participation in the treatment process were carried out. Methods were used: systematic approach, bibliosemantic, analytical.
 Results. In modern conditions, partner participation of patients in the treatment process has become a mandatory component of the development of a patient- centered model of medical care and is recommended by the WHO. A necessary component of this process is the implementation of shared decision-making strategy by the doctor and the patient. Organizational approaches to the implementation of the shared decision-making strategy in clinical practice are being improved and generalized, in particular, in 2021 NICE (Great Britain) experts published guideline NG197 «Shared decision-making». One of the most important factors of the shared decision-making strategy implementation in clinical practice is the training of medical staff on improving communication skills and empathy, engaging the patient to independent control of the disease, etc. WHO pays considerable attention to the engaging of patients self-management of health status and treatment results, as a component of patient partnership in the organization of medical care. It has been proven that self-management programs reduce the number of unplanned hospitalizations of patients with chronic obstructive pulmonary disease and bronchial asthma, heart failure, etc. A wide range of approaches have been proposed to support patient engagement in self-management and partnership in treatment, including information leaflets, online peer support, individual counselling, group educational sessions, telephone coaching, symptom monitoring technologies and change interventions psychological behavior.
 Conclusions: The implementation of a patient-centered model of medical care requires engaging patients in the treatment process as partners, which involves joint decision-making by the doctor and patient and self-management. It is essential to improve the communication skills of physicians and educate patients about participating in shared decision-making and self-management.

Dermatologists Communication Skills and Performance From Point of View of Patients.

Effective communication is an important issue in patient-doctor interaction which is even more important regarding chronic disorders which need a strong relationship between patient and clinician for better compliance and optimal control disease. This study was aimed to develop the best cultural adapted Persian version of the 28-item Calgary- Cambridge Observation Guide (CCOG) questionnaire. In this descriptive-analytic study, data collected from 400 patients attending the outpatient dermatology clinics of 3 major hospitals in Tehran using the modified Persian version of CCOG questionnaire, both before and after being visited by dermatologists. The difference of CCG scores for all of questions, except for questions number 1,16 and 22, was statistically significant. The highest score, both before and after visiting, attained by question regarding being respectful. The lowest scores for necessary behavior and the adequate amount of execution were related to questions number 3 (Introducing self) and 4 (Introducing role), respectively. Age and educational level of patients were significantly correlated with their expectations regarding communication skills of clinician. This study showed the acceptable validity of modified Persian version of CCOG-24 item questionnaire. Our findings also demonstrated that there was a significant difference between what patients expected from a dermatologist and the manner they actually were treated regarding physician communication skills.

The complexity of physician-patient communication and its impact in non-medical fields. A surgical oncology approach.

Physician-patient communication is essential for determining high-quality healthcare, as this may influence patients' satisfaction with care, their understanding of medical information, coping skills specific to a disease, and raise treatment adherence. In the field of surgical oncology, most healthcare communication develops around the disease, treatment, and healthcare planning, overlooking psychological functioning and patients' well-being. To address this issue and avoid unmet patient needs, patient-centered communication requires specific skills designed to enable physicians to identify, acknowledge and respond to patients' thoughts and feelings over an extended period. The aim of this study was to investigate the integration of patient-physician communication in a non-medical system made up of patient-physician communication, perceived healthcare quality, and the image of a physician or a healthcare organization with a specific focus on surgical oncology. The sample comprised 157 breast cancer patients who reported highly satisfactory levels of perceived communication skills of physicians and the quality of services. Moreover, patients expressed their willingness to recommend these physicians to their family and friends, which further contributes to the positive image of physicians. Nevertheless, it is important to emphasize the ongoing need for continuous attention to the communication skills of surgical oncologists, as each cancer patient's experience is unique and necessitates a personalized form of interaction.

Effect of multimodal comprehensive communication skills training with video analysis by artificial intelligence for physicians on acute geriatric care: a mixed-methods study

ObjectivesTo quantitatively analyse by artificial intelligence (AI) the communication skills of physicians in an acute care hospital for geriatric care following a multimodal comprehensive care communication skills training programme and...

Talking about death and dying: A delicate balance between the physician, patient, and their family caregivers

We thank the authors, Shah and Tiwari, for their evocative paper on passive euthanasia within the Indian healthcare setup.[1] The paper contributes to the larger discourse on the ethical dilemma of the right to die with human dignity. It highlights the need to initiate a dialogue within the Indian healthcare system regarding the introduction of communication skills for physicians and the practice of seeking healthy (and legal) consent when providing a diagnosis to the patient and their caregivers. This grants them the agency to actively participate in determining the quality of both their life and death. To ease the dilemma, the Indian Council of Medical Research Expert Group on “Do Not Attempt Resuscitation” (DNAR or passive euthanasia) highlighted the importance of open communication between the physicians and the patient/family caregivers to enhance the decision-making process.[2] In order to encourage open communication among the triad (patients, family caregivers, and their physicians) involved in illness communication in the Indian medical setting, it is necessary to recognize two unique aspects. First, India being a collectivist society, the agency and responsibility of the patient, especially in the case of terminal illness, are primarily vested with the family caregivers. This often overshadows the patients’ agency and role in the decision-making about their own bodies.[3] The vulnerable state of the patients renders them dependent on their family caregivers, who act as consent providers in treatment and medical decisions.[4] Despite their need for information regarding their illness and treatment, the patients play a passive role in illness communication and decision-making. Acknowledging the narratives of the authors of the current paper, research suggests that to provide consent for medical decisions, family caregivers have to engage in pragmatic questioning.[1,4] Often the family caregivers are forced to make a choice between the patient’s quality of life or continuing medical care. This dilemma results in feelings of guilt among the family caregivers. It is therefore crucial to recognize and involve the family caregivers in end-of-life decision-making and interventions. Second, patients and their caregivers in India prefer that their physicians initiate illness and treatment discussions.[4] Therefore, it is essential for physicians to lead discussions on DNAR/end-of-life. However, medical education in India does not offer training for communication skills as part of the curriculum.[5] The ramifications of not offering such training programs are also hinted at in the current paper, wherein physicians expressed fear and hesitancy to initiate conversations about DNAR with patients and caregivers.[1] It is imperative that a communication skills training program be included for physicians to focus on breaking bad news and open dialogue to having end-of-life conversations.[6] Further, cultural sensitivity needs to be incorporated while developing end-of-life interventions for patients.[7,8] To this end, we believe that achieving dignity in death is a process that begins with initiating sensitive conversations from the physician’s end. Furthermore, open and collaborative communication between the patient, physician, and family caregivers is required to ensure an ongoing dialogue on end-of-life care. This may help normalize conversations on death with dignity, bearing in mind the unique challenges of the Indian medical setting. Financial support and sponsorship The third author, Matsungshila Pongener, is funded by the Ministry of Education, Government of India. Conflicts of interest There are no conflicts of interest.

Evaluation of factors influencing physician–patientcommunication in healthcare service delivery

Physician–patient communication has received less focus in the study of healthcare service delivery in Nigeria. Themajority of communication relies on message delivery rather than interpersonal communication. Even when doctorshave significant knowledge to share with their patients, they frequently lack the interpersonal communicationskills required to do it successfully. This quantitative study employed the analysis of 150 valid responses frompracticing physicians in Lagos state. Descriptive statistics were carried out to understand the factors influencingphysician–patient communication. The results revealed good communication skills among physicians as theyagreed to have social conversations with patients, listen intently to them, and promote question-asking. Theresponses from the survey also revealed that factors such as limited consultation time and unfavorable workingenvironments could negatively impact physician–patient communication. Furthermore, the test hypothesis revealeda significant correlation between physicians’ age and gender (p<0.05), whereas physicians’ ethnicity andreligion had non-significant associations. The evaluation of factors influencing physician–patient communicationrevealed that several individual and contextual factors contribute to effective communication, including physiciancommunication skills, patient health literacy, and system-level factors such as time constraints and workload.Healthcare organizations and policymakers should prioritize efforts to improve physician–patient communicationby addressing the identified factors that influence communication and implementing evidence-based interventionsto enhance communication between physicians and patients.

Continuing Medical Education Improves Physician Communication Skills and Increases Likelihood of Pediatric Vaccination: Findings from the Pediatric Influenza Vaccination Optimization Trial (PIVOT)-II.

This study evaluated the impact of a continuing medical education (CME) program that emphasized actionable information, motivation to act, and skills to strengthen physician recommendations for seasonal influenza vaccination in children 6 through 23 months of age for whom influenza immunization rates are suboptimal. Physicians were randomly assigned to an accredited CME program or to no CME. Participants completed pre- and post-study questionnaires. Influenza immunization rates were compared between groups. A total of 33 physicians in the CME group and 35 in the control group documented 292 and 322 healthy baby visits, respectively. Significantly more parents immunized their children against influenza after interacting with CME-trained physicians than those with no CME training (52.9% vs. 40.7%; p = 0.007). The odds ratio for vaccination after visits with CME-trained physicians was 1.52 (95% confidence interval 1.09 to 2.12; p = 0.014), which was unaffected by the socioeconomic status of parents. Parents who discussed influenza vaccination with CME-trained physicians were 20% more likely to choose an approved but publicly unfunded adjuvanted pediatric influenza vaccine. The percentages of physicians reporting the highest levels of knowledge, ability, and confidence doubled or tripled after the CME intervention. Significantly more parents immunized very young children after interacting with physicians who had undergone CME training.

Com-On Questionnaire: Development and validation of a questionnaire for evaluating communication skills of oncologists.

The present study aimed to develop and validate an instrument for assessing the communication skills of oncology physicians from a patient's point of view. A first draft of the questionnaire was compiled based on skills reflecting good physician-patient communication identified in the literature. The questionnaire was critically revised by experts to ensure the validity of its contents. The revised questionnaire was completed by a sample of 153 cancer patients. The questionnaire was developed in German and later translated into English. After analysis using classical test theory and an exploratory factor analysis, four different factors could be extracted. These factors were labelled setting, patient-centeredness, empathy and consulting competencies. Unsuitable items were eliminated within the analysis. All remaining items hold an appropriate degree of selectivity, item difficulty and reliability/consistency. A novel questionnaire for evaluating communication skills of physicians was developed. It contains 36 items and is named 'Com-On Questionnaire: Questionnaire for the Evaluation of Physician's Communication Skills in Oncology'. The questionnaire is suitable for measuring both the strengths and deficits within the physician-patient communication in oncology from the patients' perspective.

Physician Communication Skills in Telemedicine: The Role of Eye Contact.

Gaze is an important non-verbal behavior in patient-physician communication. We examine the effect of the physician's gaze direction in video consultations on their communication and interpersonal skills ratings. 51 subjects watched videos of a physician providing the same teleconsultations while (a) looking directly at the camera and (b) looking at the computer screen. After each video, the participants rated the physician's skills. The results showed that looking at the camera is perceived as making eye contact and is associated with higher ratings on two communication skill items: (1) using empathy to communicate appreciation of the patient's feelings, and (2) providing support by expressing concern, understanding, and willingness to help. The effect of eye contact depended on the content of the consultation and on the general attitude of the physician. These results highlight the role of eye contact in video consultations and its dependency on other verbal and non-verbal behaviors.

Video-Based Communication Assessment of Physician Error Disclosure Skills by Crowdsourced Laypeople and Patient Advocates Who Experienced Medical Harm: Reliability Assessment With Generalizability Theory.

BackgroundResidents may benefit from simulated practice with personalized feedback to prepare for high-stakes disclosure conversations with patients after harmful errors and to meet American Council on Graduate Medical Education mandates. Ideally, feedback would come from patients who have experienced communication after medical harm, but medical researchers and leaders have found it difficult to reach this community, which has made this approach impractical at scale. The Video-Based Communication Assessment app is designed to engage crowdsourced laypeople to rate physician communication skills but has not been evaluated for use with medical harm scenarios.ObjectiveWe aimed to compare the reliability of 2 assessment groups (crowdsourced laypeople and patient advocates) in rating physician error disclosure communication skills using the Video-Based Communication Assessment app.MethodsInternal medicine residents used the Video-Based Communication Assessment app; the case, which consisted of 3 sequential vignettes, depicted a delayed diagnosis of breast cancer. Panels of patient advocates who have experienced harmful medical error, either personally or through a family member, and crowdsourced laypeople used a 5-point scale to rate the residents’ error disclosure communication skills (6 items) based on audiorecorded responses. Ratings were aggregated across items and vignettes to create a numerical communication score for each physician. We used analysis of variance, to compare stringency, and Pearson correlation between patient advocates and laypeople, to identify whether rank order would be preserved between groups. We used generalizability theory to examine the difference in assessment reliability between patient advocates and laypeople.ResultsInternal medicine residents (n=20) used the Video-Based Communication Assessment app. All patient advocates (n=8) and 42 of 59 crowdsourced laypeople who had been recruited provided complete, high-quality ratings. Patient advocates rated communication more stringently than crowdsourced laypeople (patient advocates: mean 3.19, SD 0.55; laypeople: mean 3.55, SD 0.40; P<.001), but patient advocates’ and crowdsourced laypeople’s ratings of physicians were highly correlated (r=0.82, P<.001). Reliability for 8 raters and 6 vignettes was acceptable (patient advocates: G coefficient 0.82; crowdsourced laypeople: G coefficient 0.65). Decision studies estimated that 12 crowdsourced layperson raters and 9 vignettes would yield an acceptable G coefficient of 0.75.ConclusionsCrowdsourced laypeople may represent a sustainable source of reliable assessments of physician error disclosure skills. For a simulated case involving delayed diagnosis of breast cancer, laypeople correctly identified high and low performers. However, at least 12 raters and 9 vignettes are required to ensure adequate reliability and future studies are warranted. Crowdsourced laypeople rate less stringently than raters who have experienced harm. Future research should examine the value of the Video-Based Communication Assessment app for formative assessment, summative assessment, and just-in-time coaching of error disclosure communication skills.