Date of Award

January 2015

Document Type

Open Access Thesis

Degree Name

Master of Public Health (MPH)

Department

School of Public Health

First Advisor

Paul D. Cleary

Second Advisor

David Y. Hwang

Abstract

Background: Physician communication skills during a medical visit may be a central factor in achieving optimal patient experience because it improves the exchange of important clinical and psychosocial information. While many medical schools emphasize communication skills training for students, formal training in patient-centered communication for housestaff has received less attention. Few studies have examined communication skills training for housestaff with regards to its impact on actual patient experience survey results.

Aim: To assess whether an education initiative that teaches patient-centered strategies for starting medical interview improves housestaff perception and patient experiences in the resident clinics and inpatient wards.

Method: We conducted a prospective pre-post intervention study in the Departments of Neurology, Neurosurgery, and Urology. Between February and April 2014, housestaff participated in two-hour educational session about the five strategic steps to open a medical interview that combined didactic and skills practicing including lectures and role-play simulation. Outcome measures were questionnaire administered to the house-staff of their evaluations of the communication skills training program and pre- (January-February 2014) and post- (June-July 2014) patient-reported surveys (CG-CAHPS and HCAHPS) of related patient-doctor communication questions. Chi-square test was used to compare dichotomized responses (top-box items) and examine differences between pre- and post- test scores.

Results: Forty-four of a possible 45 residents (97.8%) at Yale School of Medicine participated. After the intervention, 70.5% of resident’s perception of the value of the 5-step patient-centered interview increased. The response rates to the outpatient surveys were similar during the pre- (63/122, 52%) and post-intervention (77/157, 49%) periods (p = 0.67). No statistically significant difference in patient responses on outpatient survey items was seen between the pre- and post-intervention period, including items regarding whether the resident listened carefully (pre-intervention “Yes” responses = 93.7%, 50th national percentile; post = 90.9%, 25th percentile; p = 0.15) and whether the resident showed respect (pre = 92.1%, < 25% percentile; post = 96.0%, 60th percentile; p = 0.74). Similarly, mean score of doctor’s communication with patients on inpatient surveys were greater than 71.0% and we found no statistically significant difference between pre- and post- tests (p-value > 0.05). Subgroup analyses comparing pre- and post- within each department and demographic factors were performed and results showed no statistically significant difference (p-value > 0.05). When mean scores were compared to the national percentile data, more than half of the clinics in the nation have higher scores than our institution.

Conclusions: While an interdepartmental educational program was both feasible and well received, demonstrating an improvement in patient experience surveys in response to such a program remains challenging. We recommend that academic medical centers develop a holistic strategy for teaching communication skills over a sufficient duration that integrates several evidence based techniques. Academic medical centers should actively incorporate communication skills training in their curricula and aggressively train all doctors and nurses.

Comments

This is an Open Access Thesis.

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