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Pre- & Post-Training Assessment of Residents’ Performance in the Fourth ACGME Competency: Patient Communication Skills.
Rajiv Chandawarkar1, *Aleksandra Krajewski1, *Kimberly Ruscher1, Rekha Singh1, *Carol Pfeiffer1, *Beth Lesnikoski2, Robert Kozol2, Walter Longo3, *Prakash Nadkarni3
1UCONN School of Medicine, Farmington, CT;2Florida Atlantic University, West Palm, FL;3Yale University School of Medicine, New Haven, CT
Structured communication curricula will improve surgical residents’ ability to communicate effectively with patients.
Design Setting: Prospective, IRB-approved study involved 44 general-surgery residents from University of Connecticut. Residents initially filled out a written Baseline Survey to assess general awareness of communication-skills. Step-1: Residents were randomized to one of two simulations using Standardized-Patient-Instructors (SPs) to mimic patients recently detected with either breast or rectal cancer and are receiving news with respect to their diagnosis. Residents’ communication skills were scored by the SPs using standardized scales: Content -Checklist (CC) & Master- Interview-Rating-Scale (MIRS). Step-2: Residents attended a 3-part interactive program that comprised: (a) principles of patient-communication; (b) experiences of a surgeon (his role as physician, patient and spouse of a patient); (c) Role-play: 3-resident group played roles of a patient, physician and an observer and scored their performance. Step-3: Residents were re-tested as in Step-1 using a cross-over case design. Scores were analyzed using Wilcoxon’s Signed-rank test and the Bonferroni correction.
Results: Content-Checklist median scores improved from 8.5(65%) to 11.0(84%)[P = 0.005]. The MIRS median per-item score of improved from 3.625 to 3.844. Major improvement was in the ability to communicate ‘ Need for Support Systems’. Difference between Rectal and Breast Cancer scores were not significant indicating that the cross-over design was successful.
Conclusions: This study assesses residents’ baseline communication skills in written tests and clinical vignettes and shows that a simple patient-centered communication training exercise can measurably (using two established scales) improve residents’ patient-communication skills.
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