COMMENTARY

Patients Can Make You a Better Resident

Rosalyn E. Plotzker, MD, MPH

Disclosures

August 06, 2018

It goes something like this: At 400 PM on Friday, before the beginning of his first "golden weekend" in a month, Thomas met with the residency program's assistant director for a year-end evaluation. Thomas had done well on his in-service exam. His peer reviews from coresidents were positive. He miraculously had only one outstanding administrative chore. Finally, the assistant director passed a few papers to Thomas. "Here are some patient feedback surveys where you were mentioned."

Thomas read the top paper: "Dr Thomas and Dr Ivan worked well together." The rest simply had his name printed on the top of the page, after "Provider." Rows of boxes were lined up underneath a scale of 1-5, like a stack of bricks. Each row had a box that was blackened, indicating varying degrees of satisfaction:

  • Were the patients' questions addressed?

  • Was the language Thomas used easy to understand?

  • Did the patients feel comfortable with their plans of care?

Thomas scanned the rows. Finally, he looked up from the papers at the assistant director, who smiled back and said "You did fine." That was the end. It was time for sign-out.

Measuring Patient Centeredness

Seventeen years ago, the Institute of Medicine—now the National Academy of Medicine—identified patient-centeredness as one of six healthcare quality goals. Since then, the importance of a patient's experience has been embedded into the rubric of quality measurements for healthcare facilities. It naturally follows that medical education is tasked with teaching trainees the skills to provide patient-centered care, with an emphasis on communication and interpersonal sensitivity.

In medical school, this takes the form of objective structured clinical examinations (OSCEs). Standardized patients have scripted complaints, with a clear scoring system to evaluate students on certain factors that contribute to the patient's experience. During residency, when trainees apply these skills to real-world, scriptless patients, what better way to evaluate a resident than to simply ask the patients themselves? This is easier said than done.

There is no Accreditation Council for Graduate Medical Education-standardized method for how patient feedback is solicited during residency, nor how that feedback is delivered to trainees. Some programs offer patients a paper form or postvisit electronic survey if they want to voluntarily submit reflections about their experience. As one resident pointed out to me recently, this is a self-selecting group of patients. "It's kind of like getting a Yelp review. You get people who had a particularly great experience. You get people who had a pretty awful experience. And sometimes you have people who were disappointed because they had high expectations, probably because they talked to people who had a particularly great experience."

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