Resident Training Method Boosts Certain Communication Skills

Steven Fox

August 16, 2011

August 16, 2011 — Patient communication skills need to be taught as part of residency training, according to a study appearing in the August issue of the Archives of Surgery (a theme issue of the journal focusing on surgical training). With limited short-term training, case-specific skills improved more than general communications skills, the article states.

Lead author Rajiv Chandawarker, MD, from the Department of Plastic Surgery, University of Connecticut School of Medicine, Farmington, and colleagues note that surgical residents do not usually get formal training in how to communicate with patients, but instead learn those skills on the job.

However, the authors say, the Accreditation Council for Graduate Medical Education considers good communication to be a core competency skill and requires that residency programs document formal processes for assessing how well residents communicate. Another requirement is to provide residents with feedback on both clinical competence and interpersonal communication. Role playing, using standardized patients (usually actors), is a common, widely accepted training method for assessing both sets of these skills.

"The goal of this project was to teach surgical residents to incorporate patient-centered communication skills into their practice, providing emotional support, transition, and continuity of care, as well as information and education, involving family and friends and respecting patient values and differences," the authors write.

They designed a 3-step pilot study that involved 44 general surgery residents.

In the first step, residents were given a written baseline survey to assess their general awareness of communication skills. Then they were randomly assigned to 1 of 2 patient interaction simulations in which they delivered a diagnosis of either breast cancer or rectal cancer to standardized patient instructors. The instructors scored the residents' communication skills with the use of a case-specific checklist and a Median Master Interview Rating Scale.

In step 2, the residents participated in an interactive program designed to educate them on principles of effective patient communication. The program also included role-playing segments, with the residents acting as physicians, patients, and patients' spouses. They also rated each other's performance in those roles.

In step 3, the residents were retested the same way as in step 1, using a crossover design, to see what progress they had made.

With regard to their findings, the researchers write: "Our results show a discrepancy between measured improvement in condition-specific communication skills and measured improvement in general communications skills."

More specifically, the authors report that case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%; P = .005 by Wilcoxon signed rank test for paired ordinal data).

However, scores for Median Master Interview Rating Scale rose only from 58.0 before testing to 61.5 after testing, which was not statistically significant. The authors also did not observe significant differences between overall rectal cancer scores and breast cancer scores.

Dr. Chandawarker and his group say their results indicate that case-specific improvements appear to be more amenable to measurable improvement than general communications skills, at least in the context of the short-term training they used in the pilot study.

"Such skills can be assessed over a longer period, perhaps by incorporating this model and assessments from year to year," they write, adding that the methods they used could be readily adapted for use by other teaching hospitals and community health centers.

The authors conclude by stressing the crucial importance of surgeons developing and using good skills to communicate with their patients. "Without communication skills, even the best surgical training would be rendered ineffective," they write.

The study was supported by the 2010 Picker Foundation Educational Challenge. The authors have disclosed no relevant financial relationships.

Arch Surg. 2011;146:916-921. Abstract