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      Communication Skills Training for Physicians Improves Patient Satisfaction

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          Abstract

          BACKGROUND

          Skilled physician communication is a key component of patient experience. Large-scale studies of exposure to communication skills training and its impact on patient satisfaction have not been conducted.

          OBJECTIVE

          We aimed to examine the impact of experiential relationship-centered physician communication skills training on patient satisfaction and physician experience.

          DESIGN

          This was an observational study.

          SETTING

          The study was conducted at a large, multispecialty academic medical center.

          PARTICIPANTS

          Participants included 1537 attending physicians who participated in, and 1951 physicians who did not participate in, communication skills training between 1 August 2013 and 30 April 2014.

          INTERVENTION

          An 8-h block of interactive didactics, live or video skill demonstrations, and small group and large group skills practice sessions using a relationship-centered model.

          MAIN MEASURES

          Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), Clinician and Group Consumer Assessment of Healthcare Providers and Systems (CGCAHPS), Jefferson Scale of Empathy (JSE), Maslach Burnout Inventory (MBI), self-efficacy, and post course satisfaction.

          KEY RESULTS

          Following the course, adjusted overall CGCAHPS scores for physician communication were higher for intervention physicians than for controls (92.09 vs. 91.09, p < 0.03). No significant interactions were noted between physician specialty or baseline CGCAHPS and improvement following the course. Significant improvement in the post-course HCAHPS Respect domain adjusted mean was seen in intervention versus control groups (91.08 vs. 88.79, p = 0.02) and smaller, non-statistically significant improvements were also seen for adjusted HCAHPS communication scores (83.95 vs. 82.73, p = 0.22). Physicians reported high course satisfaction and showed significant improvement in empathy (116.4 ± 12.7 vs. 124 ± 11.9, p < 0.001) and burnout, including all measures of emotional exhaustion, depersonalization, and personal accomplishment. Less depersonalization and greater personal accomplishment were sustained for at least 3 months.

          CONCLUSIONS

          System-wide relationship-centered communication skills training improved patient satisfaction scores, improved physician empathy, self-efficacy, and reduced physician burnout. Further research is necessary to examine longer-term sustainability of such interventions.

          Electronic supplementary material

          The online version of this article (doi:10.1007/s11606-016-3597-2) contains supplementary material, which is available to authorized users.

          Related collections

          Most cited references26

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          Effect of communications training on medical student performance.

          Although physicians' communication skills have been found to be related to clinical outcomes and patient satisfaction, teaching of communication skills has not been fully integrated into many medical school curricula or adequately evaluated with large-scale controlled trials. To determine whether communications training for medical students improves specific competencies known to affect outcomes of care. A communications curriculum instituted in 2000-2001 at 3 US medical schools was evaluated with objective structured clinical examinations (OSCEs). The same OSCEs were administered to a comparison cohort of students in the year before the intervention. One hundred thirty-eight randomly selected medical students (38% of eligible students) in the comparison cohort, tested at the beginning and end of their third year (1999-2000), and 155 students in the intervention cohort (42% of eligible students), tested at the beginning and end of their third year (2000-2001). Comprehensive communications curricula were developed at each school using an established educational model for teaching and practicing core communication skills and engaging students in self-reflection on their performance. Communications teaching was integrated with clinical material during the third year, required clerkships, and was supported by formal faculty development. Standardized patients assessed student performance in OSCEs on 21 skills related to 5 key patient care tasks: relationship development and maintenance, patient assessment, education and counseling, negotiation and shared decision making, and organization and time management. Scores were calculated as percentage of maximum possible performance. Adjusting for baseline differences, students exposed to the intervention significantly outperformed those in the comparison cohort on the overall OSCE (65.4% vs 60.4%; 5.1% difference; 95% confidence interval [CI], 3.9%-6.3%; P<.001), relationship development and maintenance (5.3% difference; 95% CI, 3.8%-6.7%; P<.001), organization and time management (1.8% difference; 95% CI, 1.0%-2.7%; P<.001), and subsets of cases addressing patient assessment (6.7% difference; 95% CI, 5.9%-7.8%; P<.001) and negotiation and shared decision making (5.7% difference; 95% CI, 4.5%-6.9%; P<.001). Similar effects were found at each of the 3 schools, though they differed in magnitude. Communications curricula using an established educational model significantly improved third-year students' overall communications competence as well as their skills in relationship building, organization and time management, patient assessment, and negotiation and shared decision making-tasks that are important to positive patient outcomes. Improvements were observed at each of the 3 schools despite adaptation of the intervention to the local curriculum and culture.
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            Effect of communication skills training program for oncologists based on patient preferences for communication when receiving bad news: a randomized controlled trial.

            The aim of this study was to identify the effects of a communication skills training (CST) program for oncologists, developed based on patient preferences regarding oncologists' communication.
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              Psychometric properties of the Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Adult Visit Survey.

              The Consumer Assessment of Healthcare Providers and Systems (CAHPS®) Clinician and Group Adult Visit Survey enables patients to report their experiences with outpatient medical offices. To evaluate the factor structure and reliability of the CAHPS Clinician and Group (CG-CAHPS) Adult Visit Survey. Data from 21,318 patients receiving care in 450 clinical practice sites collected from March 2010 to December 2010 were analyzed from the CG-CAHPS Database. Individual level and multilevel confirmatory factor analyses were used to examine CAHPS survey responses at the patient and practice site levels. We also estimated internal consistency reliability and practice site level reliability. Correlations among multi-item composites and correlations between the composites and 2 global rating items were examined. Scores on CG-CAHPS composites assessing Access to Care, Doctor Communication, Courteous/Helpful Staff, and 2 global ratings of whether one would Recommend their Doctor, and an Overall Doctor Rating. Analyses provide support for the hypothesized 3-factor model assessing Access to Care, Doctor Communication, and Courteous/Helpful Staff. In addition, the internal consistency reliabilities were ≥ 0.77 and practice site level reliabilities for sites with >4 clinicians were ≥ 0.75. All composites were positively and significantly correlated with the 2 global rating items, with Doctor Communication having the strongest relationship with the global ratings. The CG-CAHPS Adult Visit Survey has acceptable psychometric properties at the individual level and practice site level. The analyses suggest that the survey items are measuring their intended concepts and yield reliable information.
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                Author and article information

                Contributors
                216-445-8076 , boissya@ccf.org
                Journal
                J Gen Intern Med
                J Gen Intern Med
                Journal of General Internal Medicine
                Springer US (New York )
                0884-8734
                1525-1497
                26 February 2016
                July 2016
                : 31
                : 7
                : 755-761
                Affiliations
                [1 ] GRID grid.239578.2, ISNI 0000000106754725, Office of Patient Experience, Center for Excellence in Healthcare Communication, , Cleveland Clinic, ; 9500 Euclid Ave, NA4, Cleveland, OH 44195 USA
                [2 ] GRID grid.239578.2, ISNI 0000000106754725, Quantitative Health Sciences, , Cleveland Clinic, ; Cleveland, OH USA
                [3 ] GRID grid.257413.6, ISNI 0000000122873919, , Indiana University School of Medicine, ; Indianapolis, IN USA
                [4 ]Press Ganey Associates, Inc., Chicago, IL USA
                [5 ] GRID grid.239578.2, ISNI 0000000106754725, Center for Value-Based Care Research, Medicine Institute, , Cleveland Clinic, ; Cleveland, OH USA
                Article
                PMC4907940 PMC4907940 4907940 3597
                10.1007/s11606-016-3597-2
                4907940
                26921153
                6404cc9f-bf77-4732-b8ee-ec4f98240dda
                © Society of General Internal Medicine 2016
                History
                : 25 August 2015
                : 17 December 2015
                : 14 January 2016
                Categories
                Original Research
                Custom metadata
                © Society of General Internal Medicine 2016

                communication,patient experience,patient satisfaction,CGCAHPS,HCAHPS,burnout,empathy,physician

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