Physician-patient Communication Skills Research Articles

Learning and assessment strategies to develop specific and transversal competencies for a humanized medical education.

Introduction: Medical education should promote the development of skills and abilities that can be applied to real-world work performance. The aim of this study is to evaluate technical and methodological knowledge, as well as physician-patient communication skills, as one of the most important transversal competencies that a good physician should acquire; all this in a reliable, accurate and objective way. Methods: We present a rubric specifically designed and implemented for the evaluation of specific and transversal competencies in the physiology practical sessions, during the second year of the medical degree. The assessment consists in two evaluation tests: 1) a theoretical test that consists of multiple-choice questions. Students must demonstrate that they have acquired adequate theoretical knowledge (specific competency "to know"); 2) a practical test, in which students are evaluated by the rubric through the simulation of a medical consultation. Thus, demonstrating their ability to execute/apply what they have learned in class (specific competency "to know how to do"). They are also evaluated on the transversal competencies that we call "communication with the patient" (transversal competency "to know how to be there") and "dealing with the patient" (transversal competency "to know how to be"). Results: We evaluated whether there were differences in the grades obtained by students when the transversal competencies were not assessed (academic years 2017-2018 and 2018-2019; n = 289), and when the transversal competencies were assessed by applying the rubric in the academic years 2019-2020, 2021-2022, and 2022-2023 (n = 526). Furthermore, we present a student perception that supports the use of clinical simulation and our rubric as a good method within the competency learning process. Discussion: The acquisition of these competencies, starting from the first courses of undergraduate education, helps to raise the students' awareness in the development of a more humanized medicine, allowing a better response to the patients' needs. Our rubric, which clearly indicate the performance criteria, have become an excellent method to carry out the assessment of competencies, both for students and teachers, since they allow to obtain clear evidence of the level of acquisition and application of knowledge.

DEVELOPMENT OF MEDIA LITERACY AND COMMUNICATION SKILLS BY MEANS OF DIGITAL STORYTELLING IN JAPAN

The research substantiates Japanese experience of media literacy and oral communication skills development by digital storytelling (DST); reveals theoretical background and current practical application of DST in higher education of Japan. DST has significant advantages as an individual- and situation-oriented tool of oral communication as well as the instrument of psychological and learning influence on society. It is continuously implemented into Japanese educational and social practice. Famous universities of Japan initiate and realize scientific and academic projects, extending communication connections of Japanese population, improving their skills of critical thinking and argumentation, developing desires and abilities to communicate freely, fluently, confidently and persuasively. At present DST shows a positive growing tendency as a teaching and learning tool in higher education of both Japan and Ukraine. This is primarily linked with the global processes of social digitalization, computerization of education and urgent transferring to distance learning due to the COVID-19 pandemic. Evidence-based studies prove the efficacy of DST as the learning and evaluation instrument of oral communication skills, i. e. in English. Moreover, the technology can be applied in different specialties, i. e. medical one. The healthcare branch was drastically influenced by quarantine restrictions, having resulted in fundamental transformations of teaching and learning approaches, implementation of e-learning and telemedicine. DST has a confirmed positive influence on public health and medical knowledge development. In higher medical education it can be used as a new type of virtual patients. DST can improve physician-patient communication skills, professional qualities, tolerance and empathy. Our research confirms the potential of DST as a powerful developmental tool of media literacy and oral communication skills, and proves the requirement for the implementation of Japanese experience into higher education of Ukraine.

A Novel Serious Illness Communication Curriculum Improves Neurology Residents' Confidence and Skills.

Background and Purpose: Competency in serious illness communication is mandated by the Accreditation Council of Graduate Medical Education. Previous efforts to teach communication skills have been hampered by intensive time requirements. In this study, we developed and evaluated a brief goals-of-care communication curriculum for neurology residents. Methods: We developed and implemented a two-part curriculum based on themes identified from a needs assessment: (1) fundamental physician-patient communication skills; and (2) counseling surrogate decision makers and providing neuroprognostication. We used a three-pronged pre-post study design to evaluate the impact of the curriculum: resident self-assessment surveys, direct observations of resident-patient interactions, and patient perception surveys using the Communication Assessment Tool. Results: Residents reported a significant increase in mean scores [standard deviation] of confidence practicing fundamental communication skills, such as offering opportunities for emotion (3.84 [0.9] vs. 4.54 [0.6], p = 0.002), and goals-of-care communication skills, such as using triggers for serious conversations (2.65 [0.7] vs. 3.29 [0.5], p = 0.004). Observed resident-patient interactions showed significant improvement in fundamental communication skills, such as involving the patient in decision making (1.89 [0.6] vs. 4.0 [0.9], p < 0.001). There was no significant impact on patient perception of resident communication skills in the three months following the intervention. Conclusions: A brief, learner-centered curricular intervention improved neurology residents' confidence in serious illness communication and improved their skills as judged by trained observers.

Physician-patient agreement on physicians’ communication skills and visit satisfaction in dermatology clinics: a one-with-many design

IntroductionThere is limited research on physician–patient communication skills that covers both sides of the relationship. The aim of this study was to explore two indicators of effective physician-patient communication: the agreement of physicians’ and patients’ perspectives of physicians’ communication skills in outpatient visits to dermatology clinics and the relationship of these perceptions of the consultation with their visit satisfaction.Material and methodsDermatologists (n = 8) and their patients (n = 122) completed post-consultation dyadic measures of the content (what the physician communicates) and process (how the physician communicates) of the communication and satisfaction with a single office visit. Multilevel modelling was used to investigate the patient and doctor variance components at both the dyad and the doctor levels.ResultsThe patients rated the communication content skills higher than the physicians did; however, the doctors rated themselves as better skilled at the process of communication. There was disagreement between the physicians’ and the patients’ ratings of the both physicians’ content and process skills. In contrast, there was a high level of consensus amongst patients of the same doctor about the content and process of the doctor’s communication skills, while the physicians did not perceive themselves as consistent in communication between one patient and another. However, both the physicians and the patients who reported uniquely the highest physicians’ communication skills had higher visit satisfaction. Moreover, the patients who perceived their physicians as having good communication process skills on average had higher visit satisfaction.ConclusionsAlthough the perspectives of the same visit differed, self-rated behaviour affected satisfaction with visit.

Analyzing Expert Criteria for Authentic Resident Communication Skills

Phenomenon : Training and assessing communication skills requires flexible and holistic approaches, including feedback practices. Historically, assessing communication skills has predominantly relied on itemized scoring, which is less useful for providing meaningful feedback to learners. Even more troublesome, theoretical scoring criteria tend to become a refractive lens allowing observation of only the conduct that aligns with the theory. Few skills assessment efforts have embraced a holistic understanding of how physician-patient communication skills are enacted in real patient care. Therefore, this study focused on what experts refer to when they speak about physicians’ communication skills and what they treat as important when evaluating these skills enacted during real patient encounters. Approach : This qualitative study was based on observations and grounded theory. Residents’ encounters with real patients were recorded as part of a formative communication skills assessment program from July 2015 to June 2016. Evaluation panels with diverse backgrounds (e.g., medicine, education, communication, conversation analysis, and layperson) listened to these recordings and jointly developed feedback comments for the resident from January 2016 to July 2017. For this study, we recorded forty-one panel discussions to observe their consensus evaluation. We conducted open and axial coding using a constant comparison approach to generate themes from the data. Findings : Elements of communication skills were connected and interdependent around the concepts of thoroughness and natural flow, which were not addressed by formative assessment criteria. Themes included (1) thoroughness within a boundary via agenda-setting; (2) natural yet, controlled flow: authentic conversation by active listening and questioning; (3) making agenda setting explicit to all parties in the beginning; (4) designing questions using both open-ended and closed questions; (5) pre-/post-conditions for patient education: patient contextual factors and teach-back; (6) preconditions for shared decision-making: patient education and patient contextual factors; and (7) multifaceted empathy demonstrated in multiple ways. Insights : The main message of the study findings is that communication skills criteria should be treated as organically interrelated and connected in assessing physicians’ communication skills. Current communication skills assessment practice should be revisited as it itemizes physicians’ communication skills as distinct and separate constructs rather than mutually affecting dynamics. Rather than imposing a theoretical rubric, assessment criteria should evolve through naturalistic observations of physician-patient communication.

The Psychological Effects of Physicians' Communication Skills on COVID-19 Patients.

PurposeThe COVID-19 pandemic has affected physician–patient communication (PPC) in multiple ways. This study aims to report on the impact of physician–patient communication (PPC) skills on COVID-19 patients’ psychology in Jordan.Sample and MethodsIn this study, two questionnaires were designed. The first questionnaire targeted physicians, with 72 responses, and the second questionnaire targeted patients, with 248 responses. Both questionnaires contained common sections covering nine aspects of communication such as empathy, honesty, optimism, simple and deliberateness.ResultsThis study found that the psychological effect of physicians’ positive communication skills on COVID-19 patients is significant. There were almost statistical agreement between physicians’ and patients’ questionnaire responses that the physicians’ communication skills have positively affected the patients’ psychological status; all patients’ responses confirmed this finding.ConclusionBased on this study’s findings, appropriate and continuous training will advance physicians’ communication skills in the form of exercises that could be as simple as class- or lecture-based activities, or using technology-based learning. Using a protocol or handbook to guide such communication is another essential strategy to enhance physician–patient communication (PPC). The study recommends that physicians must be aware that PPC skills required may vary depending on whether they are dealing with a pandemic or non-pandemic situation. Generally, appropriate or positive communication skills are considered one of the main factors effecting patients’ psychological responses to their diagnosis.

Designing and Psychometric Assessing of Physician-Patient Communication Skills Tool

Background: Assessment of physicians’ communication skills with patients is essential to ensure effective treatment. Achieving such a goal requires the use of a valid, native, and culturally-based tool. This study aimed to design a physician-patient communication skills assessment tool and evaluate its validity and reliability among the medical students of Guilan University of Medical Sciences, Rasht City, Iran. Methods: In this cross-sectional, descriptive, and analytical study, out of 400 medical students (interns), 300 were selected by a stratified random sampling method. The initial tool with 30 items was evaluated by calculating the item impact index in the target group. Also, its ratio and content validity indexes were assessed by 10 experts’ views and factor analysis. The reliability of the research tool was confirmed by assessing the internal consistency by calculating the Cronbach alpha value. Results: Out of the 30 initial items, after calculating the item impact score index of higher than 1.5, the content validity ratio greater than 0.51, the content validity index higher than 0.79, and exploratory factor analysis,18 items remained and were considered suitable for the physician-patient communication skills assessment tool. Then, these variables were loaded considering the amount of special value greater than 1 under four factors. The reliability of the research tool was confirmed by calculating the Cronbach alpha coefficient of 0.92. The instrument was also confirmed by confirmatory factor analysis regarding its appropriate fitness indices. This study provided a proper and native instrument with 18 valid and reliable items for the assessment of physician-patient communication skills in medical students. Conclusion: The results of this study could be of interest to researchers in evaluating physician-patient communication skills in other medical sciences universities of Iran.

Physician’s work environment and its relation to physician–patient communication skills

Physician’s work environment and its relation to physician–patient communication skills

Online Physician Reviews Do Not Reflect Patient Satisfaction Survey Responses

Online physician reviews have become increasingly prevalent and are a common means by which patients explore medical options online. Currently, there are no data comparing physicians with negative online reviews and those without negative reviews. We sought to compare industry-vetted patient satisfaction surveys (PSSs), such as Press Ganey (PG) PSSs, between those physicians with negative online reviews and those without negative reviews. Overall, there were 113 unique individuals with negative online reviews from September 1, 2014, to December 31, 2014, with 8 being nonphysicians. We matched 113 physicians in similar departments/divisions. We obtained PG PSS scores of both groups and compared the mean scores of the 2 groups. Press Ganey PSS scores were available for 98 physicians with negative online reviews compared with 82 matched physicians without negative online reviews. The mean raw PG PSS scores were not different between the 2 groups (4.05; 95% CI, 3.99-4.11 vs 4.04; 95% CI, 3.97-4.11; P=.92). We also noted no difference in mean scores on questions related to physician-patient communication and interaction skills between those with poor online reviews and those without (4.38; 95% CI, 4.32-4.43 vs 4.41; 95% CI, 4.35-4.47; P=.42). However, there was a significantly lower non–physician-specific mean in those with negative online reviews (3.91; 95% CI, 3.84-3.97) vs those without negative online reviews (4.01; 95% CI, 3.95-4.09) (P=.02). Here, we provide data indicating that online physician reviews do not correlate to formal institutional PG PSS. Furthermore, physicians with negative online reviews have lower scores on non–physician-specific variables included in the PG PSSs, emphasizing that these discrepancies can negatively affect overall patient experience, online physician reviews, and physician reputation. It is prudent that an improved mechanism for online ratings be implemented to better inform patients about a physician's online reputation.

Effect of a brief patient communication teaching on both attendee and non-attendee family medicine residents

Physician-patient communication skills are important for physicians to acquire. Teaching skills is thought to require attendance by learners but this is difficult in graduate medical education settings. We asked if an educational intervention on physician-patient communication was associated with a "spill-over" effect to non-attendees in the same family medicine residency program.

The application of situational heuristic teaching method in the teaching of acupuncture and moxi-bustion

Objective Aiming at the characteristics of the course of acupuncture and massage, to discuss the application of Situational heuristic teaching. Methods 60 undergraduate students in Grade Four of Jiangxi University of Traditional Chinese Medicine(clinical practice)were even divided into 2 groups, that was situational teaching group(the experimental group)and the traditional teaching group(control group). The students in the experimental group received basic theory course of 30 hours, 60 hours in the course of situational teaching. The clinical cases of teaching were carefully designed according to the simu-lated hospital scene in each chapter, including large cases, acupuncture and massage therapy program, which were conducted between teachers and students through interactive and positive research and other forms. In the control group the teachers taught the content to students in class for full 90 hours in accor-dance with the requirements of the teaching syllabus. Taking objective theoretical examination, subjective questionnaire survey, and subjective clinical return visit questionnaire scores as indicators the difference of the two kinds of teaching methods were compared and statistical analysis was carried out by SPSS 19.0 software, chi square test and t test. Results By comparison of objective theoretical examination results of two groups of subjects, the number of good students in the experimental group was 10, and the number of outstanding students was 7, with an average of(80.63±1.35)points. In the control group, the number of good students was 9, the number of outstanding students was 6, with the average score of(80.54±1.32), and the average score of the objective theory test scores were not statistically significant(P>0.05). The learning satisfaction of the students in the experimental group was(3.91±0.29). Students in the experimental group thought situation heuristic teaching was conducive to professional development(3.23 ± 0.39), to improving the learning quality(3.68 ± 0.72), clinical thinking culture(4.11±0.24), clinical ability(3.72±0.27), clinical physician-patient communication skills(3.28±0.79), basic clinical skills(3.48±0.42)points, with teaching satisfaction(4.19±0.25), which were all higher than the control group, and the difference was statistically significant(P<0.05). Conclusion Situational heuristic teaching method is better than the traditional teach-ing method in stimulating students' learning enthusiasm, innovation ability, cultivating professional interest and cultivating students' clinical practice ability. The teaching practice of teachers should give full play to the advantages of the method and improve the teaching effect, which is worthy of further research and pro-motion. Key words: Situational heuristic teaching; Acupuncture and moxibustion; Application

Assessing effective physician-patient communication skills: "Are you listening to me, doc?".

The education of a physician includes much more than acquiring competence in medical knowledge and technical expertise. Physicians also need to have excellent communication skills in order to communicate with patients. Communication skills form the foundation for a more positive patient-provider relationship, leading to greater patient satisfaction and better patient compliance. In the patient’s eyes, the ability to communicate well forms a major component of a provider’s clinical competence. The ability to communicate effectively with patients can contribute significantly to improved patient outcomes. Because of their importance in the practice of medicine, teaching interviewing and communication skills are a part of the curriculum for medical schools. At the Mayo Medical School, a tool was developed to assist in the assessment of medical students when communicating with patients as they elicit a medical history. This rubric has been very useful for both teaching and assessment, and it may be applicable to other healthcare settings as well. Patients commonly complain that physicians do not listen to them. “Being a good doctor requires not only knowledge and technical skills, but also communication” [1]. Communication skills are not just restricted to talking, but also to listening and nonverbal communication [2]. Assessment of the provider’s ability to apply communication skills continues to be a concern of medical educators. Developing a positive relationship has historically contributed a great deal to a physician’s effectiveness and satisfaction within the profession [3]. Such relationships are crucial for successful medical treatment [4]. Good communication skills are a key to establishing these desired relationships, and the inability to display good communication skills has been shown to negatively affect many areas in patient care [5]. On the other hand, good communication skills have been shown to improve patient treatment compliance, thus leading to improved patient outcomes [6]. The benefits of good communication skills have been documented in the literature and recognized by physicians as early as Osler [7], who encouraged physicians to “care more particularly for the individual patient than for the special features of the disease.” Ludmerer [8] noted, “For over a century, the goal of medical education has been to produce thinking physicians, scientifically competent, who are sensitive to the emotional as well as the medical condition of the patient.” Unfortunately, there is evidence that suggests good communication skills are not universally practiced by physicians [5].

Role of the Medical Practitioners Emotional Intelligence on Patient Satisfaction

Physician-patient communication skills linked to improved patient satisfaction. More emotionally intelligent persons might succeed at communicating in pleasing ways. Physicians communication skills are potentially valuable assets to improve quality of care. This study examined the relationship between physicians emotional intelligence (EI) and patient satisfaction. The sample comprised physicians of different specializations and their patients. EI was measured using Genos Emotional Intelligence Inventory. Patient satisfaction was assessed by Patient Satisfaction Questionnaire-III. The Karl Pearsons coefficient of correlation resulted positive and significant association between EI and patient satisfaction. Moreover, EI scores of a physician showed strong positive associations with communication sub-scales of patient satisfaction. Linear regression analysis showed EI is a significant predictor of patient satisfaction. ANOVA results depicted that physicians EI changes across age and experience and also patient satisfaction changes across gender, age, follow-up visit, education, and marital status. It has implications for physicians that improved EI abilities contribute to increased communication quality. Increased communication skills act as a better predictor of patients needs that ultimately contribute to satisfy the patient. Physicians EI abilities are strengthened through training programs on EI, which are necessarily effective in the workplace.

Why Educators Should Apply Theories and Models of Health Education and Health Promotion to Teach Communication Skills to Nursing and Medical Students.

Why medical and nursing students need education in communication skills? And how these skills should be thought? These are two important questions in medical education. Effective communication between health care providers and their clients is a crucial factor in patient-centered care. Identifying clients’ needs and taking appropriate actions to overcome these problems need appropriate communication skills (1). Providing effective communication skills to nursing and midwifery students and helping them to reflect this on both work and personal lives is one of the main goals of education (2). According to Simonson (3), 25 years ago, formal writing courses were not offered at about 86 of 101 (85%) responding American medical schools. Furthermore, regarding his professional commitment, he hoped that his residents as well as other medical students would benefit from “formal professional written and verbal communication” programs soon. After 25 years, thanks to very admirable efforts of educational policy makers, the number of medical schools that offer formal communication skills has been significantly increased; however, the number of patient complaints about physicians and nurses communication skills has been dramatically increased. For instance, in content analysis of 1216 complaints of patients by Montini et al., “poor provider-patient communication” contributed to 17% of complaints (4). In a study in Turkey, nursing students’ mean score of communication skills scale was 165.27, which showed a moderate level of these skills (2). Benbassat found that teaching interviewing skills to medical students had serious problems. First the students were faced with wide variability in interviewing styles and different role models, second clinical teachers were not usually specialists in patient interviewing and third there was no valid method for assessment of interviewing skills (5). It seems that the efficacy of our communication skills programs is still under question and as Simonson has recommended, it needs something more than theoretical teaching (3). For instance, role modeling, critical reflections and formative and summative evaluations should be integrated in teaching programs. The role of theories in designing and conducting medical and nursing education is well defined. Learning theories are popular within nursing education and many important notions such as self-monitoring and simulation design have been derived from these theories. Sociocultural theories have been largely overlooked in medical and nursing education (6). It is believed that theories and models in health education and health promotion (HEHP) should be used in planning, implementing and evaluation of any educational programs about communication skills to enhance the success rate of educational programs (7). In “effective training strategies for teaching communication skills to physicians: an overview of systematic reviews” (8), the methodological errors of studies were reported as one of the limitations of overview. Reporting such an error in many studies supports the idea of using theories and models of HEHP in teaching communication skills. Indeed, applying theories and models would decrease methodological errors of studies, which in turn, would allow instructional designers to access many valid and reliable educational strategies. Applying theories and models of HEHP in instructional designs regarding communication skills should be a crucial concern of educators; otherwise, their blind attempts to improve medical students’ communication skills would usually fail to succeed. Moreover, using different constructs of theories and models of HEHP lets educators recognize constructs which are the most important predictors of physicians’ successful communication behaviors. Consequently, designing educational programs based on highly predictive constructs would be the key to their success. Based on social, epidemiological, educational and administrative and policy assessment, performed in a recent Ph.D. dissertation in Tarbiat Modarres University, Precede–Proceed model was the effective model for planning interns’ physician-patient communication skills and for the most part, the items from interviews with 14 faculty members and 7 medical interns were matched with the constructs of Social Cognitive Theory. Based on confirmatory factor analysis (CFA), the most important predictors of successful communication behavior among interns were recognized and used to write lesson plans to train participants in the intervention group of the educational quasi-experimental study (IRCT2013021812511N1). Having a good grasp of theories and models of HEHP and practicing theories and models of HEHP in formal communication courses by educators and health leaders would improve the outcome measures of communication skills programs. For this reason, educators should appreciate that theories and models are for all health care administers, not just for students.

Physician-patient communication skills: e-tools.

Center of Clinical Neuroscience, University Clinic Dresden Carl Gustav Carus, University of Technology Dresden, Fetscherstrase 74, 01307, Dresden, Germany *Author for correspondence: Tel.: +49 351 458 4465; Tjalf.Ziemssen@uniklinikum-dresden.de

Interventions to Promote a Patient-Centered Approach in Clinical Consultations: Improving the Physician-Patient Communication Skills of Thomas Jefferson University Hospitals’ Residents and Fellows

Interventions to Promote a Patient-Centered Approach in Clinical Consultations: Improving the Physician-Patient Communication Skills of Thomas Jefferson University Hospitals’ Residents and Fellows Voichita Bar-Ad, MD; Tu Dan, MD; Jennifer Arfaa; John McAna; Nicholas G. Zaorsky, MD; John Caruso, MD; Richard Jacoby, MD; Christopher Skidmore, MD; Austin Katona; Bettina Berman; Mark Hurwitz, MD; Elisabeth J.S. Kunkel, MD Abstract Background: Patient-centered communication is a critical component of patient-centered care. The purpose of this study was to evaluate the efficacy of a training course in patient-communication. Materials: A training course for resident physicians and fellows was initiated in 2011. The course utilized the Acknowledge, Introduction, Duration, Explanation, Thanking (AIDETTM) framework. In the quarter year following the training, a survey was sent to evaluate the trainees’ self-assessed physician-patient communication skills. Results: Of the 885 trainees who received the survey, 241 responded (response rate, 27%). Those attending the AIDETTM training were significantly more likely to report that they praised the care provided by other teams (p=0.01) and to leave contact information for the patient (p=0.02). In addition, those who underwent AIDETTM training were more likely to report that they received adequate communication skills training during residency and fellowship (p=0.045). Conclusions: AIDETTM training is associated with better scores on self-assessed physician-patient communication skills. Full Text: PDF DOI: 10.15640/ijhs.v3n2a4

Can a simplified approach to emotional intelligence be the key to learner-centered teaching?

Emotional intelligence (EQ) is the ability to recognize and understand emotions, and to use this awareness to manage your own behavior and relationships.1 Widely popular in business and psychology, its medical practice applications have largely been limited to practice management and physician-patient communication skills.2–,5 In graduate medical education, EQ has been applied to educate learners in use of self-awareness and interpersonal and communication skills with colleagues and patients. EQ has the potential to improve other interpersonal interactions. For example, it can help faculty develop more effective learner-centered experiences by individualizing curricula, providing more meaningful feedback, and improving remediation programs.6,7

Electronic Health Record Training in Undergraduate Medical Education

While electronic health record (EHR) use is becoming state-of-the-art, deliberate teaching of health care information technology (HCIT) competencies is not keeping pace with burgeoning use. Medical students require training to become skilled users of HCIT, but formal pedagogy within undergraduate medical education (UME) is sparse. How can medical educators best meet the needs of learners while integrating EHRs into medical education and practice? How can they help learners preserve and foster effective communication skills within the computerized setting? In general, how can UME curricula be devised for skilled use of EHRs to enhance rather than hinder provision of effective, humanistic health care?Within this Perspective, the authors build on recent publications that "set the stage" for next steps: EHR curricula innovation and implementation as concrete embodiments of theoretical underpinnings. They elaborate on previous calls for maximizing benefits and minimizing risks of EHR use with sufficient focus on physician-patient communication skills and for developing core competencies within medical education. The authors describe bridging theory into practice with systematic longitudinal curriculum development for EHR training in UME at their institution, informed by Kern and colleagues' curriculum development framework, narrative medicine, and reflective practice. They consider this innovation within a broader perspective-the overarching goal of empowering undergraduate medical students' patient- and relationship-centered skills while effectively demonstrating HCIT-related skills.

Assessing Physician-Patient Communication and Shared Decision-making Skills in IBD Patient Care: ACG/AstraZeneca Fellow Award: Presidential Poster

Purpose: A paradigm of shared decision-making (SDM) is increasingly recognized as an effective strategy for information exchange, but is not formally evaluated in gastroenterology fellowship training. Given its management complexities, the field of inflammatory bowel disease (IBD) represents fertile ground for the evaluation of an SDM strategy to patient care. We assessed this clinical skillset in gastroenterology (GI) fellows through the use of novel objective structured clinical examinations (OSCEs). Methods: Twelve second-year GI fellows from five GI fellowship programs participated in a four-station OSCE. Previously validated OSCE checklists were used to assess the GI fellows' performance in IBD-specific cases, two of which will be discussed here. In the first case (“New Diagnosis” or “ND case”), the goal of the GI fellow was to educate a patient on her recent diagnosis of ulcerative colitis and to navigate a complex conversation about her risk of colon cancer. In the second case (“SDM case”), the objective was to evaluate a patient with Crohn's disease who would benefit from combination therapy with infliximab and azathioprine. Each station was videotaped and observed live by faculty gastroenterologists. Checklists were scored independently by the physician-observer and the standardized patient (SP), who both provided feedback to the fellow immediately following each case. Post-OSCE, fellows attended a debriefing session on patient communication, and were surveyed to assess their perspective on the exam's educational value. Results: For the ND case, the majority of fellows received high ratings for patient interaction (11/12, 91.7%), appropriate non-verbal behavior (8/12, 66.7%), and providing clear explanations and information (11/12, 91.7%). However, 10/12 (83.3%) did not assess the SP's comprehension of the concept of endoscopic surveillance of dysplasia, and only 4/12 (33.3%) educated the patient on alarm symptoms that would require urgent consultation. In the SDM case, 8/12 (66.6%) did not completely elicit the SP's preferences regarding treatment, although 9/12 (75%) shared the treatment decision with the SP. The vast majority recognized patient factors that are considered high-risk for complications (11/12, 91.7%) and discussed mucosal healing as an endpoint (9/12, 75%). The fellows rated the OSCE experience highly, regarding its educational value, and noted improvement in their IBD-specific knowledge after the exercise. Conclusion: To our knowledge, this is the first OSCE designed specifically for assessing SDM in IBD patient care. OSCEs are a particularly valuable educational tool for the evaluation of interpersonal and communicative competency in the field of IBD.

"Best practice" for patient-centered communication: a narrative review.

Communicating with patients has long been identified as an important physician competency. More recently, there is a growing consensus regarding the components that define physician-patient communication. There continues to be emphasis on both the need to teach and to assess the communication skills of physicians. This narrative review aims to summarize the work that has been conducted in physician-patient communication that supports the efficacy of good communications skills. This work may also help to define the physician-patient communication skills that need to be taught and assessed. A review of the literature shows it contains impressive evidence supporting positive associations between physician communication behaviors and positive patient outcomes, such as patient recall, patient understanding, and patient adherence to therapy. There is a consensus about what constitutes "best practice" for physician communication in medical encounters: (1) fostering the relationship, (2) gathering information, (3) providing information, (4) making decisions, (5) responding to emotions, and (6) enabling disease- and treatment-related behavior. Evidence supports the importance of communication skills as a dimension of physician competence. Effort to enhance teaching of communication skills to medical trainees likely will require significant changes in instruction at undergraduate and graduate levels, as well as changes in assessing the developing communication skills of physicians. An added critical dimension is faculty understanding of the importance of communication skills, and their commitment to helping trainees develop those skills.