Real-patient evaluation of communication skills teaching for GP registrars

Patient feedback questionnaires to enhance consultation skills of healthcare professionals: A systematic review

OBJECTIVE

To identify patient feedback questionnaires that assess the development of consultation skills (CSs) of practitioners.

METHODS

We conducted a systematic search using seven databases from inception to January 2017 to identify self-completed patient feedback questionnaires assessing and enhancing the development of CSs of individual practitioners. Results were checked for eligibility by three authors, and disagreements were resolved by discussion. Reference lists of relevant studies and Open Grey were searched for additional studies.

RESULTS

Of 16,312 studies retrieved, sixteen were included, describing twelve patient feedback questionnaires that were mostly designed for physicians in primary care settings. Most questionnaires had limited data regarding their psychometric properties, except for the Doctor Interpersonal Skills Questionnaire (DISQ). Most studies conducted follow-up, capturing positive views of practitioners regarding the process (n = 14). Feedback was repeated by only three studies, demonstrating different levels of improvement in practitioners' performance.

CONCLUSION

Identified questionnaires were mainly focused on physicians, however, to support using patient feedback, questionnaires need to be validated with other practitioners.

PRACTICE IMPLICATIONS

Several patient feedback questionnaires are available, showing potential for supporting practitioners' development. Valid questionnaires should be used with appropriate practitioners in developing more evidence for the impact they may have on actual consultations.

The Doctor-Patient Relationship in US Primary Care

Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor–patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to three key factors in these relationships—namely, an asymmetry of perceptions on the two sides, belying the notion of a meeting of experts; the importance on both sides of ‘liking’; and the value set by both parties on development of trust. The last two of these factors are probably related to continuity of care, now under threat.

Depersonalised doctors: a cross-sectional study of 564 doctors, 760 consultations and 1876 patient reports in UK general practice

OBJECTIVES

The objectives of this study were to assess burnout in a sample of general practitioners (GPs), to determine factors associated with depersonalisation and to investigate its impact on doctors' consultations with patients.

DESIGN

Cross-sectional, postal survey of GPs using the Maslach Burnout Inventory (MBI). Patient survey and tape-recording of consultations for a subsample of respondents stratified by their MBI scores, gender and duration of General Medical Council registration.

SETTING

UK general practice.

PARTICIPANTS

GPs within NHS Essex.

PRIMARY AND SECONDARY OUTCOME MEASURES

Scores on MBI subscales (depersonalisation, emotional exhaustion, personal accomplishment); scores on Doctors' Interpersonal Skills Questionnaire and patient-centredness scores attributed to tape-recorded consultations by independent observers.

RESULTS

In the postal survey, 564/789 (71%) GPs completed the MBI. High levels of emotional exhaustion (261/564 doctors, 46%) and depersonalisation (237 doctors, 42%) and low levels of personal accomplishment (190 doctors, 34%) were reported. Depersonalisation scores were related to characteristics of the doctor and the practice. Male doctors reported significantly higher (p<0.001) depersonalisation than female doctors. Doctors registered with the General Medical Council under 20 years had significantly higher (p=0.005) depersonalisation scores than those registered for longer. Doctors in group practices had significantly higher (p=0.001) depersonalisation scores than single-handed practitioners. Thirty-eight doctors agreed to complete the patient survey (n=1876 patients) and audio-record consultations (n=760 consultations). Depersonalised doctors were significantly more likely (p=0.03) to consult with patients who reported seeing their 'usual doctor'. There were no significant associations between doctors' depersonalisation and their patient-rated interpersonal skills or observed patient-centredness.

CONCLUSIONS

This is the largest number of doctors completing the MBI with the highest levels of depersonalisation reported. Despite experiencing substantial depersonalisation, doctors' feelings of burnout were not detected by patients or independent observers. Such levels of burnout are, however, worrying and imply a need for action by doctors themselves, their medical colleagues, professional bodies, healthcare organisations and the Department of Health.

The patient's role in the assessment of students' communication skills

The central focus of this study was to investigate the effects of the introduction of a new system of formative assessment on students' perceptions of their communication skills, by recruiting patients to assess the student who provided their treatment on that day. The assessment tool detailed 12 aspects of communication and the patient 'scored' the student from 0 (representing very poor skills) to 10 (representing excellence). The patients then handed the completed form at the end of the treatment session to the student. This would then form part of their clinical portfolio for reflection and consideration. A pilot scheme was implemented with the consent of staff, students and patients. Minor adjustments were made to the forms to clarify more precisely the point for assessment. The communication visual analogue scale demonstrated a perceived improvement over the ten-week period 86.4% for the experienced students and 80% for the novice students. The students who were interviewed all stated that they were comfortable with the patients assessing them and for some it made them feel more confident. Some students were surprised by the marks that the patients gave on some aspects of their communication, particularly pertaining to maintaining eye contact.

Can the feedback of patient assessments, brief training, or their combination, improve the interpersonal skills of primary care physicians? A systematic review

BACKGROUND

Improving quality of primary care is a key focus of international health policy. Current quality improvement efforts place a large focus on technical, clinical aspects of quality, but a comprehensive approach to quality improvement should also include interpersonal care. Two methods of improving the quality of interpersonal care in primary care have been proposed. One involves the feedback of patient assessments of interpersonal care to physicians, and the other involves brief training and education programmes. This study therefore reviewed the efficacy of (i) feedback of real patient assessments of interpersonal care skills, (ii) brief training focused on the improvement of interpersonal care (iii) interventions combining both (i) and (ii)

METHODS

Systematic review of randomised controlled trials. Three electronic databases were searched (CENTRAL, Medline and Embase) and augmented by searches of the bibliographies of retrieved articles. The quality of studies was appraised and results summarised in narrative form.

RESULTS

Nine studies were included (two patient based feedback studies and seven brief training studies). Of the two feedback studies, one reported a significant positive effect. Only one training study reported a significant positive effect.

CONCLUSION

There is limited evidence concerning the effects of patient based feedback. There is reasonable evidence that brief training as currently delivered is not effective, although the evidence is not definitive, due to the small number of trials and the variation in the training methods and goals. The lack of effectiveness of these methods may reflect a number of issues, such as differences in the effectiveness of the interventions in experienced practitioners and those in training, the lack of theory linking feedback to behaviour change, failure to provide sufficient training or to use a comprehensive range of behaviour change techniques. Further research into both feedback and brief training interventions is required before these interventions are routinely introduced to improve patient satisfaction with interpersonal care in primary care. The interventions to be tested in future research should consider using insights from the wider literature on communication outside primary care, might benefit from a clearer theoretical basis, and should examine the use of combined brief training and feedback.

Development and feasibility of a patient feedback programme to improve consultation skills in general practice training

OBJECTIVE

To develop an attractive and effective patient feedback training programme for general practice trainees (GPTs).

METHODS

First, an exploratory study was conducted in which patients and GPTs were interviewed after they had worked with patient feedback. This contributed to the development of the patient feedback training programme. Subsequently, in a feasibility study, first-year GPTs asked patients to give feedback on their consultation skills by completing a questionnaire. The outcomes of group discussions with the GPTs and the results of the evaluation forms filled in by the GPTs were analysed.

RESULTS

Forty-eight GPTs collected 878 questionnaires. GPTs and patients alike expected patient feedback to be a major tool for acquiring consultation skills. The GPTs encountered several obstacles in the organisation of this programme in their practice. They reported that the learning effects were more limited than they had expected because patients gave positively biased answers and because not all consultations provided an appropriate source of patient feedback.

CONCLUSION

The new patient feedback programme on consultation skills is feasible for patients and GPTs.

PRACTICE IMPLICATIONS

To optimise the educational potential and benefits of patient feedback, GPTs should ask for feedback from patients after challenging consultations, and should stimulate patients to be critical in their answers.

Identifying criteria for the assessment of pharmacy students' communication skills with patients

OBJECTIVES

To identify criteria by which patients can assess the communication skills of pharmacy students.

METHOD

Potential assessment criteria were generated from 2 main sources: a literature review and a focus group discussion. A modified two-round Delphi survey was subsequently conducted with 35 professionals who were actively involved in teaching and assessing communication skills of pharmacy students to determine the importance and reliability of each criterion.

RESULTS

Consensus ratings identified 7 criteria that were important measures of pharmacy students' communication skills and could be reliably assessed by patients.

CONCLUSIONS

A modified two-round Delphi consultation survey successfully identified criteria that can be used by patients to assess the communication skills of pharmacy undergraduates. Future work will examine the feasibility of using patients as assessors of communication skills of pharmacy students, preregistration pharmacists, and qualified pharmacists.

Enhancing emotional intelligence in the health care environment: an exploratory study

Emotional intelligence (EI), or knowledge of how emotions function in self and others, is a popular construct in both scientific and professional communities. Current theoretical models suggest that EI is a combination of dynamic skills that can be learned and enhanced through participation in targeted intervention programs. Although popular, few if any of the aforementioned interventions have been subjected to empirical scrutiny. Consistent with calls for efficacy studies of intervention programs, the purpose of this exploratory study was to examine the effect of an adventure-based intervention on the EI of employees of a multisite dental practice. Fifteen individuals completed the Mayer-Salovey-Caruso Emotional Intelligence Test before and after participation in a day-long intervention. Results suggest that the intervention had a small but positive effect on the participants' EI and that improvements in the 4 branches of EI varied within employee subgroups. Implications for future research and practical considerations for the health care environment are discussed.

The doctor-patient relationship in US primary care

Changes in the organization of primary care in the UK are driven by a need to improve access and availability, but doctor-patient relationships may suffer. To investigate the importance of such relationships in a different setting, we analysed focus-group data obtained in a primary care facility in the USA (Rochester, NY). The findings pointed to three key factors in these relationships-namely, an asymmetry of perceptions on the two sides, belying the notion of a meeting of experts; the importance on both sides of 'liking'; and the value set by both parties on development of trust. The last two of these factors are probably related to continuity of care, now under threat.

Physician communication skills training: a review of theoretical backgrounds, objectives and skills

CONTEXT

Significant shortcomings have been noted in the literature in communication skills training for practising doctors. Given the importance of competent communication to the doctor-patient relationship and health care in general, these shortcomings should be addressed in future research.

OBJECTIVE

Research into physician communication skills training is examined with respect to the communication objectives and behaviours that are addressed.

METHODS

A Medline search of literature from 1990 to the present was conducted.

RESULTS

A total of 26 studies of doctor communication skills training were found. The majority of studies included insufficient information about the communication behaviours taught to participants. In several studies, there was a mismatch between stated behaviours and instruments or procedures used to assess them.

CONCLUSION

Three recommendations are suggested. Firstly, future researchers should take greater care in matching assessment instruments with stated communication skills. Secondly, researchers should provide and use a theoretical framework for selecting communication skills to address in interventions, and thirdly, the timing of communication skills within the interview context should be part of the instruction in interventions.

Communication skills training in healthcare: a review of the literature

This article is based on a literature review carried out as part of a study of communication skills teaching in pre-registration nurse education in England in 2000. The rationale for the study was two-fold: the history of patient dissatisfaction with communications and information-giving in the National Health Service and concern about skills deficits in alumnae of recent educational programmes. A lack of research evaluating communications skills training was found in relation to both pre- and post-registration nursing education, and in other healthcare disciplines. Furthermore, the research that has been done is limited by methodological deficiencies in many cases. Recommendations are made concerning improved methods for future research evaluating communication skills training.

Medical student interviewing skills and mother-reported satisfaction and recall

BACKGROUND

Providing feedback to medical students about their interviewing skills is an important component of teaching programmes. There is very little information about mothers' views of medical student consultations in paediatrics, and in particular about what mothers consider to be the key elements of a successful consultation. Patient-centred interviewing is a model which emphasizes the active seeking of patient views. In association with appropriate clinical skills, it is reported to promote improved health outcomes.

OBJECTIVES

To examine whether greater medical student clinical competence and more frequent use of patient-centred techniques is associated with higher maternal satisfaction, higher maternal rating of the medical student's interpersonal skills, and greater maternal recall of relevant diagnosis and treatment recommendations.

METHOD

Two standardized 'medical student' videotaped interviews were created based on actual senior medical student consultations. Interview A demonstrated both higher student clinical competence and higher patient-centredness compared with interview B. Both videotaped interviews were viewed and then rated, using a questionnaire, by 11 mothers attending a teaching general practice.

RESULTS

Significantly higher mean scores, indicating greater maternal satisfaction, were associated with interview A (P < 0.01 for all measures). Accurate recall for diagnosis and management was also significantly greater after interview A (mean diagnosis recall, interview A 35%, interview B 14%, P < 0.01; mean management recall, interview A 95%, interview B 57%, P < 0.01).

CONCLUSIONS

Maternal satisfaction and recall were higher following a more clinically competent and patient-centred medical student interview. Maternal ratings of student interviews could be used as an additional method of assessment as well as providing feedback to medical students on their interview skills development.

EFFECTS OF ASSERTIVE COMMUNICATION BETWEEN DOCTORS AND PATIENTS IN PUBLIC HEALTH OUTPATIENT SURGERIES IN THE CITY OF SEVILLE (SPAIN)

This research investigated the quality of communication between doctors and patients of the Public Health Services in the city of Seville, Spain. Two hundred and twenty-eight doctors were selected at random from all of the clinics in the city for interviews. The interviews were guided by a specially composed questionnaire, which obtained answers to 30 variables grouped under four headings: variables which influence doctor-patient communication, interest in the consultation, information used in the consultation, and qualities of doctor-patient communication. Chi-squared tests were carried out on the different groups, which confirmed the objectives proposed in the investigation – among which was the need to set up communications training programs for doctors in order to improve their communication skills.