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Improving Physician-Patient Communication Through Coaching of Simulated Encounters

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Abstract

Objective

Effective communication between physicians and their patients is important in optimizing patient care. This project tested a brief, intensive, interactive medical education intervention using coaching and standardized psychiatric patients to teach physician-patient communication to family medicine trainees.

Methods

Twenty-six family medicine trainees (9 PGY1, 11 PGY2, 6 fellows) from five university-affiliated hospitals conducted four once-weekly, 30-minute videotaped interviews with “difficult” standardized patients. After each interview, trainees received 1 hour of individual coaching that incorporated self-assessment and skills-teaching from experienced psychiatrists. Two follow-up interviews with standardized patients occurred 1 week and an average of 6 months post-intervention. Trainee self-reported physician-patient communication efficacy was measured as a control 1 month before the intervention; during the month of the intervention; and an average of 6 months after the intervention. Coach-rated physician-patient communication competence was measured each week of the intervention.

Results

Improvements in physician-patient communication were demonstrated. Self-efficacy for physician-patient communication improved significantly during the intervention, in contrast to no improvement during the control period (i.e., training-as-usual). This improvement was sustained during the follow-upperiod.

Conclusions

This innovative educational intervention was shown to be highly effective in improving trainee communication competence and self-efficacy. Future applications of this brief model of physician training have potential to improve communication competence and, in turn, can improve patient care.

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References

  1. Simpson M, Buckman R, Stewart M, et al: Doctor-patient communication: the Toronto consensus statement. BMJ 1991; 303:1385–1387

    Article  CAS  PubMed  Google Scholar 

  2. Mead N, Bower P: Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Couns 2002; 48:51–61

    Article  PubMed  Google Scholar 

  3. Levinson W, Roter DL, Mullooly JP, et al: Physician-patient communication: the relationship with malpractice claims among primary care physicians and surgeons. JAMA 1997; 277:553–559

    Article  CAS  PubMed  Google Scholar 

  4. Accreditation Council for Graduate Medical Education: ACGME Learning Portfolio, 2011; available at http://www.acgme.org/acWebsite/home/home.asp

  5. Royal College of Physicians and Surgeons of Canada: Canadian Medical Education Directions for Specialists, 2011; available from http://rcpsc.medical.org/canmeds/index.php

  6. Hinchey SA, Jackson JL: A cohort study assessing difficult patient encounters in a walk-in primary care clinic: predictors and outcomes. J Gen Intern Med 2011; 26:588–594

    Article  PubMed Central  PubMed  Google Scholar 

  7. Bandura A: Social cognitive theory of self-regulation. Organ Behav Hum Decis Process 1991; 50:248–287

    Article  Google Scholar 

  8. Makoul G: Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 2001; 76:390–393

    Article  CAS  PubMed  Google Scholar 

  9. Larson EB, Yao X: Clinical empathy as emotional labor in the patient-physician relationship. JAMA 2005; 293:1100–1106

    Article  CAS  PubMed  Google Scholar 

  10. Heritage J, Maynard DW: Problems and prospects in the study of physician-patient interaction: 30 years of research. Annu Rev Sociol 2006; 32:351–374

    Article  Google Scholar 

  11. Cegala DJ, Lenzmeier Broz S: Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ 2002; 36:1004–1016

    Article  PubMed  Google Scholar 

  12. Smith RC, Marshall-Dorsey AA, Osborn GG, et al: Evidence-based guidelines for teaching patient-centered interviewing. Patient Educ Couns 2000; 39:27–36

    Article  CAS  PubMed  Google Scholar 

  13. Zoppi K, Epstein RM: Is communication a skill? communication behaviors and being in relation. Fam Med 2002; 34: 319–324

    PubMed  Google Scholar 

  14. Stein T, Frankel RM, Krupat E: Enhancing clinician communication skills in a large healthcare organization: a longitudinal case study. Patient Educ Couns 2005; 58:4–12

    Article  PubMed  Google Scholar 

  15. Boyle D, Dwinnell B, Platt F: Invite, listen, and summarize: a patient-centered communication technique. Acad Med 2005; 80:29–32

    Article  PubMed  Google Scholar 

  16. Aspegren K: BEME Guide No. 2: Teaching and learning communication skills in medicine: a review with quality grading of articles. Med Teach 1999; 21:563–570

    Article  CAS  PubMed  Google Scholar 

  17. Rao J, Anderson L, Inui T, et al: Communication interventions make a difference in conversations between physician and patient. Med Care 2007; 45:340–349

    Article  PubMed  Google Scholar 

  18. Sargeant JM, Mann KV, van der Vleuten CP, et al: Reflection: a link between receiving and using assessment feedback. Adv Health Sci Educ Theory Pract 2009; 14:399–410

    Article  PubMed  Google Scholar 

  19. Stoltenberg C, McNeil B, Delworth U: IDM Supervision: An Integrated Developmental Model for Supervising Counselors and Supervisors. San Francisco, Jossey-Bass, 1998

    Google Scholar 

  20. Ladany N: Conducting effective clinical supervision, in Psychologists’ Desk Reference, 2nd Edition. Edited by Koocher GP, Norcross JC, Hill SS. London, UK, Oxford University Press, 2005, pp 682–685

  21. Horvath AO, Del Re AC, Flückiger C, et al: Alliance in individual psychotherapy. Psychotherapy (Chic) 2011; 48:9–16

    Article  Google Scholar 

  22. Liu X: How supervisors influence performance: a multilevel study of coaching and group management in technology-mediated services. Pers Psychol 2010; 63:265–298

    Article  Google Scholar 

  23. Busari JO, Weggelaar NM, Knottnerus AC, etal: Howmedical trainees perceive the quality of supervision provided by attending doctors in the clinical setting. Med Educ 2005; 39: 653–654

    Article  Google Scholar 

  24. Bergin A, Garfield S: Handbook of Psychotherapy and Behavior Change. New York, Wiley, 1994

    Google Scholar 

  25. Hales RE, Yudofsky SC, Gabbard GO: The American Psychiatric Publishing Textbook of Psychiatry, 5th Edition. Washington, DC, American Psychiatric Publishing, Inc., 2008

    Google Scholar 

  26. Davis DA, Mazmanian PE, Fordis M, et al: Accuracy of physician self-assessment compared with observed measures of competence: a systematic review. JAMA 2006; 296:1094–1102

    Article  CAS  PubMed  Google Scholar 

  27. Kruger J, Dunning D: Unskilled and unaware of it: how difficulties in recognizing one’s own incompetence lead to inflated self-assessments. J Pers Soc Psychol 1999; 77:1121–1134

    Article  CAS  PubMed  Google Scholar 

  28. Ravitz P, Lancee WL: Improving Doctor-Patient Communication (IDPC) Orientation Manual, 2004; available from http://tinyurl.com/ccsemanual2011

  29. Tiberius R, Tipping J: Twelve Principles of Effective Teaching and Learning for Which There is Substantial Empirical Support. Toronto, Canada, University of Toronto Press, 1990

    Google Scholar 

  30. Binder J, Strupp H: Supervision of psychodynamic psychotherapies, in Handbook of Psychotherapy Supervision. Edited by Watkins CE. New York, Wiley, 1997, pp 44–62

  31. Cameron P, Ennis J, Deadman J: Standards and Guidelines for the Psychotherapies. Toronto, Canada, University of Toronto Press, 1998

    Google Scholar 

  32. Ende J: Feedback in clinical medical education. JAMA 1983; 250:777–781

    Article  CAS  PubMed  Google Scholar 

  33. Binder JL: Issues in teaching and learning time-limited psychodynamic psychotherapy. Clin Psychol Rev 1999; 19:705–719

    Article  CAS  PubMed  Google Scholar 

  34. McNaughton N, Ravitz P, Wadell A, et al: Psychiatric education and simulation: a review of the literature. Can J Psychiatry 2008; 53:85–93

    PubMed  Google Scholar 

  35. Srinivasan M, Hwang JC, West D, et al: Assessment of clinical skills using simulator technologies. Acad Psychiatry 2006; 30: 505–515

    Article  PubMed  Google Scholar 

  36. Larson LM, Suzuki LA, Gillespie KN, et al: Development and validation of the counseling self-estimate inventory. J Couns Psychol 1992; 39:105–120

    Article  Google Scholar 

  37. Hodges B, McIlroy JH: Analytic global OSCE ratings are sensitive to level of training. Med Educ 2003; 37:1012–1016

    Article  PubMed  Google Scholar 

  38. Horner RH, Carr EG, Halle J, et al: The use of single-subject research to identify evidence-based practice in special education. Except Child 2005; 71:165–179

    Google Scholar 

  39. Merton RK: The self-fulfilling prophecy. Antioch Rev 1948; 8:193–210

    Article  Google Scholar 

  40. Bernardin JH, Buckley RM: Strategies in rater training. Acad Manage Rev 1981; 6:205–212

    Google Scholar 

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Correspondence to Paula Ravitz M.D., F.R.C.P.C..

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Ravitz, P., Lancee, W.J., Lawson, A. et al. Improving Physician-Patient Communication Through Coaching of Simulated Encounters. Acad Psychiatry 37, 87–93 (2013). https://doi.org/10.1176/appi.ap.11070138

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  • DOI: https://doi.org/10.1176/appi.ap.11070138

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