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Original Article
Aug 2011

Pretraining and Posttraining Assessment of Residents' Performance in the Fourth Accreditation Council for Graduate Medical Education Competency: Patient Communication Skills

Author Affiliations

Author Affiliations: Division of Plastic Surgery (Dr Chandawarkar), Department of Surgery (Drs Ruscher, Krajewski, Garg, and Singh), and Department of Medicine (Dr Pfeiffer), University of Connecticut School of Medicine, Farmington; Center for Medical Informatics (Dr Nadkarni), Department of Surgery (Dr Longo), Yale University School of Medicine, New Haven, Connecticut; and Department of Surgery, Florida Atlantic University and JFK Medical Center, Atlantis, Florida (Drs Kozol and Lesnikoski).

Arch Surg. 2011;146(8):916-921. doi:10.1001/archsurg.2011.167

Hypothesis Structured communication curricula will improve surgical residents' ability to communicate effectively with patients.

Design and Setting A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction.

Results 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)(n = 44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P = .10) to 61.5 after testing (P = .94). Difference between overall rectal cancer scores and breast cancer scores also were not significant.

Conclusions Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.