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Smylie J, Rotondi MA, Filipenko S, Cox WTL, Smylie D, Ward C, Klopfer K, Lofters AK, O'Neill B, Graham M, Weber L, Damji AN, Devine PG, Collins J, Hardy BJ. Randomized controlled trial demonstrates novel tools to assess patient outcomes of Indigenous cultural safety training. BMC Med 2024; 22:3. [PMID: 38191406 PMCID: PMC10775432 DOI: 10.1186/s12916-023-03193-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 11/22/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND Health care routinely fails Indigenous peoples and anti-Indigenous racism is common in clinical encounters. Clinical training programs aimed to enhance Indigenous cultural safety (ICS) rely on learner reported impact assessment even though clinician self-assessment is poorly correlated with observational or patient outcome reporting. We aimed to compare the clinical impacts of intensive and brief ICS training to control, and to assess the feasibility of ICS training evaluation tools, including unannounced Indigenous standardized patient (UISP) visits. METHOD Using a prospective parallel group three-arm randomized controlled trial design and masked standardized patients, we compared the clinical impacts of the intensive interactive, professionally facilitated, 8- to10-h Sanyas ICS training; a brief 1-h anti-bias training adapted to address anti-Indigenous bias; and control continuing medical education time-attention matched to the intensive training. Participants included 58 non-Indigenous staff physicians, resident physicians and nurse practitioners from family practice clinics, and one emergency department across four teaching hospitals in Toronto, Canada. Main outcome measures were the quality of care provided during UISP visits including adjusted odds that clinician would be recommended by the UISP to a friend or family member; mean item scores on patient experience of care measure; and clinical practice guideline adherence for NSAID renewal and pain assessment. RESULTS Clinicians in the intensive or brief ICS groups had higher adjusted odds of being highly recommended to friends and family by standardized patients (OR 6.88, 95% CI 1.17 to 40.45 and OR 7.78, 95% CI 1.05 to 58.03, respectively). Adjusted mean item patient experience scores were 46% (95% CI 12% to 80%) and 40% (95% CI 2% to 78%) higher for clinicians enrolled in the intensive and brief training programs, respectively, compared to control. Small sample size precluded detection of training impacts on clinical practice guideline adherence; 100% of UISP visits were undetected by participating clinicians. CONCLUSIONS Patient-oriented evaluation design and tools including UISPs were demonstrated as feasible and effective. Results show potential impact of cultural safety training on patient recommendation of clinician and improved patient experience. A larger trial to further ascertain impact on clinical practice is needed. TRIAL REGISTRATION Clinicaltrials.org NCT05890144. Retrospectively registered on June 5, 2023.
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Affiliation(s)
- Janet Smylie
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
| | - Michael A Rotondi
- School of Kinesiology and Health Science, York University, 364 Bethune College, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada
| | - Sam Filipenko
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | | | - Diane Smylie
- Ontario Federation of Indigenous Friendship Centres, 219 Front Street East, Toronto, ON, M5A 1E8, Canada
| | - Cheryl Ward
- Anti-Indigenous Racism Consultant, Nanaimo, BC, Canada
| | - Kristina Klopfer
- Well Living House, Unity Health Toronto - St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Aisha K Lofters
- Womens College Hospital, Women's College Hospital, 77 Grenville St, Toronto, TO, M5B 2S1, Canada
| | - Braden O'Neill
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Melissa Graham
- Department of Family and Community Medicine, University of Toronto, 500 University Ave, Toronto, ON, M5G 1V7, Canada
| | - Linda Weber
- St. Josephs Heath Centre Family Medicine/Urban Family Health Team, 30 The Queensway, Toronto, ON, M6R 1B5, Canada
| | - Ali N Damji
- Credit Valley Family Health Team, 2300 Eglinton Avenue W Suite 105, Mississauga, ON, L5M2V8, Canada
| | - Patricia G Devine
- Department of Psychology, University of Wisconsin - UW-Madison, 1202 W Johnson St, Madison, WI, 53706, USA
| | | | - Billie-Jo Hardy
- Dalla Lana School of Public Health, University of Toronto, 155 College St Room 500, Toronto, ON, M5T 3M7, Canada
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Gosselin Boucher V, Bacon S, Voisard B, Dragomir AI, Gemme C, Larue F, Labbé S, Szczepanik G, Corace K, Campbell T, Vallis M, Garber G, Rouleau C, Diodati JG, Rabi D, Sultan S, Lavoie K. Assessing Physician's Motivational Communication Skills: 5-Step Mixed Methods Development Study of the Motivational Communication Competency Assessment Test. JMIR MEDICAL EDUCATION 2022; 8:e31489. [PMID: 35749167 PMCID: PMC9270716 DOI: 10.2196/31489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Revised: 01/25/2022] [Accepted: 02/12/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Training physicians to provide effective behavior change counseling using approaches such as motivational communication (MC) is an important aspect of noncommunicable chronic disease prevention and management. However, existing evaluation tools for MC skills are complex, invasive, time consuming, and impractical for use within the medical context. OBJECTIVE The objective of this study is to develop and validate a short web-based tool for evaluating health care provider (HCP) skills in MC-the Motivational Communication Competency Assessment Test (MC-CAT). METHODS Between 2016 and 2021, starting with a set of 11 previously identified core MC competencies and using a 5-step, mixed methods, integrated knowledge translation approach, the MC-CAT was created by developing a series of 4 base cases and a scoring scheme, validating the base cases and scoring scheme with international experts, creating 3 alternative versions of the 4 base cases (to create a bank of 16 cases, 4 of each type of base case) and translating the cases into French, integrating the cases into the web-based MC-CAT platform, and conducting initial internal validity assessments with university health students. RESULTS The MC-CAT assesses MC competency in 20 minutes by presenting HCPs with 4 out of a possible 16 cases (randomly selected and ordered) addressing various behavioral targets (eg, smoking, physical activity, diet, and medication adherence). Individual and global competency scores were calculated automatically for the 11 competency items across the 4 cases, providing automatic scores out of 100. From the factorial analysis of variance for the difference in competency and ranking scores, no significant differences were identified between the different case versions across individual and global competency (P=.26 to P=.97) and ranking scores (P=.24 to P=.89). The initial tests of internal consistency for rank order among the 24 student participants were in the acceptable range (α=.78). CONCLUSIONS The results suggest that MC-CAT is an internally valid tool to facilitate the evaluation of MC competencies among HCPs and is ready to undergo comprehensive psychometric property analyses with a national sample of health care providers. Once psychometric property assessments have been completed, this tool is expected to facilitate the assessment of MC skills among HCPs, skills that will better support patients in adopting healthier lifestyles, which will significantly reduce the personal, social, and economic burdens of noncommunicable chronic diseases.
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Affiliation(s)
- Vincent Gosselin Boucher
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Simon Bacon
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Health, Kinesiology and Applied Physiology, Concordia University, Montreal, QC, Canada
| | - Brigitte Voisard
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Anda I Dragomir
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Claudia Gemme
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Florent Larue
- Faculty of Medicine of Montpellier, Montpellier, France
| | - Sara Labbé
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
| | - Geneviève Szczepanik
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
| | - Kimberly Corace
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- The Royal's Institute of Mental Health Research, Ottawa, ON, Canada
| | - Tavis Campbell
- Total Cardiology Cardiac Rehabilitation, Calgary, AB, Canada
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Michael Vallis
- Department of Family Medicine, Dalhousie University, Halifax, NS, Canada
| | - Gary Garber
- Department of Medicine, University of Ottawa, Ottawa, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Codie Rouleau
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
| | - Jean G Diodati
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
| | - Doreen Rabi
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Serge Sultan
- Department of Pediatrics, Université de Montréal, Montreal, QC, Canada
| | - Kim Lavoie
- Montreal Behavioural Medicine Centre, Centre Intégré Universitaire de santé et services sociaux du Nord-de-l'Ile-de-Montréal (CIUSSSNIM), Montreal, QC, Canada
- Department of Psychology, Université du Québec à Montréal, Montréal, QC, Canada
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Abstract
OBJECTIVE The importance of physician training in communication skills for motivating patients to adopt a healthy life-style and optimize clinical outcomes is increasingly recognized. This study inventoried and systematically reviewed the psychometric properties of, and the skills assessed by, existing assessment tools used to evaluate communication skills among physicians. METHODS This review was conducted in accordance with the PRISMA guidelines (PROSPERO: CRD42018091932). Four databases (PUBMED, EMBASE, PsychINFO, and SCOPUS) were searched up to December 2018, generating 3902 unique articles, which were screened by two authors. A total of 57 articles met the inclusion criteria and underwent full data extraction. RESULTS Forty-five different assessment tools were identified. Only 47% of the studies mentioned underlying theories or models for designing the tool. Fifteen communication skills were assessed across the tools, the five most prevalent were information giving (46%) or gathering (40%), eliciting patients' perspectives (44%), planning/goal setting (37%), and closing the session (32%). Most tools (93%) assessed communication skills using in-person role play exercises with standardized (61%) or real (32%) patients, but only 54% described the expertise of the raters who performed the evaluations. Overall, reporting of the psychometric properties of the assessment tools was poor-moderate (4.5 ± 1.3 out of 9). CONCLUSIONS Despite identifying several existing physician communication assessment tools, a high degree of heterogeneity between these tools, in terms of skills assessed and study quality, was observed, and most have been poorly validated. Research is needed to rigorously develop and validate accessible, convenient, "user-friendly," and easy to administer and score communication assessment tools.
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