The feasibility and value of using patient satisfaction ratings to evaluate internal medicine residents
Cite this article as: Tamblyn, R., Benaroya, S., Snell, L. et al. J Gen Intern Med (1994) 9: 146. doi:10.1007/BF02600030 Abstract Objective: To determine the feasibility and value of using patient satisfaction ratings to evaluate the physician-patient relationship skills of medical residents. Design: A cross-sectional survey was used to collect patient satisfaction information for medical residents from all patients attending the outpatient teaching climes over a three-month period. The feasibility of patient rating was assessed by evaluating the reliability of resident satisfaction scores and potential sources of bias in rating. The value of using this method was assessed by evaluating the proportion of variance in ratings attributable to residents, the prevalence of residents with ratings substantially below average, and the effect of training on patient satisfaction. Setting: The medical clinics of two teaching hospitals at McGill University. Participants: 91 medical residents and clinical clerks, 1,003 patients, and 1,219 visit ratings. Results: An average of 12.2 satisfaction ratings were collected per resident, providing a reliability of 0.56 (intraclass correlation) for resident satisfaction score. Adjustment for differences in patient populations would be necessary to obtain comparable scores among residents. Fifteen percent of the residents had a substantially greater proportion of poor and fair satisfaction ratings than the study average. Residents were responsible for a substantial proportion of the variance in clinic waiting time and patient satisfaction rating. Training appeared to have no effect on improving satisfaction scores, except among women residents. Conclusions: Patient satisfaction ratings provide valuable information about a resident’s ability to establish an effective physician-patient relationship. However, the number of ratings required to obtain a reliable estimate of resident skill may limit the feasibility of using patient ratings as part of residency evaluation. Key words patient satisfaction resident evaluation performance assessment physician-patient relationship humanistic skills
Supported by the Royal Victoria Hospital, Department of Medicine, Research and Education Fund, and the Fonds de la recherche en santé du Québec.
Webster G. Guide to Awareness and Evaluation of Humanistic Qualities in the Internist. 2nd ed. Philadelphia: American Board of Internal Medicine, 1992;1–24.
Simpson M, Buckman R, Stewart M, et al. Doctor-patient communication: the Toronto consensus statement. BMJ. 1991;303:1385–7.
Brody DS, Miller SM, Lerman CE, Smith DG, Lazaro CG, Blum MJ. The relationship between patients’ satisfaction with their physicians and perceptions about interventions they desired and received. Med Care. 1989;27:1027–35.
DiMatteo MR, Prince LM, Taranta A. Patients’ perceptions of physicians’ behavior: determinants of patient commitment to therapeutic relationship. J Community Health. 1979;4:280–90.
Beisecker AE, Beisecker TD. Patient information-seeking behaviors when communicating with doctors. Med Care. 1990;28:19–28.
Gerace TM, Sangster JF. Factors determining patients’ satisfaction in a family practice residency teaching center. J Med Educ. 1987;62:485–90.
Comstock LM, Hooper EM, Goodwin JM, Goodwin JS. Physician behaviors that correlate with patient satisfaction. J Med Educ. 1982;57:105–12.
Bertakis KD, Roter D, Putnam SM. The relationship of physician medical interview style to patient satisfaction. J Family Pract. 1991;32(2):175–81.
Buller MK, Buller DB. Physicians’ communication style and patient satisfaction. J Health Soc Behav. 1987;28:375–88.
Winefield HR, Murrell TGC. Speech patterns and satisfaction in diagnostic and prescriptive stages of general practice consultations. Br J Med Psychol. 1991;64:103–15.
Wartman SA, Morlock IX, Malitz FE, Palm EA. Patient understanding and satisfaction as predictors of compliance. Med Care. 1983;21:886–91.
Kaplan SH, Greenfield S, Ware JE Jr. Assessing the effects of physician-patient interactions on the outcomes of chronic disease. Med Care. 1989;27(suppl):s110-s127.
Thomas KB. General practice consultations: is there any point in being positive? BMJ. 1987;294:1200–2.
Hulka BS, Kupper LL, Cassel JC, Mayo F. Doctor-patient communication and outcomes among diabetic patients. J Community Health. 1975;1:15–27.
Greenfield S, Kaplan SH, Ware JE Jr, Yano EM, Frank HJL. Patients’ participation in medical care: effects on blood sugar control and quality of life in diabetes. J Gen Intern Med. 1988;3:448–57.
Orth JE, Stiles WB, Scherwitz L, Hennrikus D, Vallbona C. Patient exposition and provider explanation in routine interviews and hypertensive patients’ blood pressure control. Health Psychol. 1987;6(1):29–42.
The Headache Study Group of the University of Western Ontario. Predictors of outcome in headache patients presenting to family physicians-a one year prospective study. Headache. 1986;26:285–94.
Falvo D, Tippy P. Communicating information to patients-patient satisfaction and adherence as associated with resident skill. J Fam Pract. 1988;26:643–7.
Stewart MA, McWhinney IR, Buck CW. The doctor/patient relationship and its effect upon outcome. J R Coll Gen Pract. 1979;29:77–82.
Bass MJ, Buck C, Turner L, Dickie C, Platt G, Robinson HC. The physician’s actions and the outcome of illness in family practice. J Fam Pract. 1986;23:43–7.
Uhlmann RF, Inui TS, Pecoraro RE, Carter WB. Relationship of patient request fulfillment to compliance, glycemic control, and other health care outcomes in insulin-dependent diabetes. J Gen Intern Med. 1988;3:458–63.
Anderson LA, Rakowski W, Hickey T. Satisfaction with clinical encounters among residents and geriatric patients. J Med Educ. 1988;63:447–55.
Woolliscroft JO, Calhoun JG, Billiu GA, Stress JK, MacDonald M, Templeton B. House officer interviewing techniques: Impact on data elicitation and patient perceptions. J Gen Intern Med. 1989;4:108–14.
Merkel WT. Physician perception of patient satisfaction: do doctors know which patients are satisfied? Med Care. 1984;22:453–9.
Durand RP, Levine JH, Lichtenstein LC, Fleming GA, Ross GR. Teachers’ perceptions concerning the relative values of personal and clinical characteristics and their influence on the assignment of students’ clinical grades. Med Educ. 1988;22:335–41.
Henken Y, Friedman M, Bouskila D, Kushnir D, Click S. The use of patients as student evaluators. Med Teacher. 1990;12:279–89.
Klessig J, Robbins AS, Wieland D, Rubenstein L. Evaluating humanistic attributes of internal medicine residents. J Gen Intern Med. 1989;4:514–21.
PSQ Project Co-Investigators. Final Report on the Patient Satisfaction Questionnaire Project. Washington, DC: American Board of Internal Medicine, 1989;2-E-1.
Health & Welfare Canada. Canada’s Health Promotion Survey. Ottawa, Ontario, Canada, 1988.
Health & Welfare Canada. The Health of Canadians. Report of the Canada Health Survey. Ottawa, Ontario, Canada, 1978; Catalog 82-538E.
Roos NP, Shapiro E. The Manitoba Longitudinal Study on Aging—preliminary findings on health care utilization by the elderly. Med Care. 1981;19:644–57.
Brennan RL. Elements of Generalizability Theory. Iowa City, IA: American College Testing Program, 1983.
Roberts JC, Tugwell P. Comparison of questionnaires determining patient satisfaction with medical care. Health Serv. Res. 1987;22:637–54.
Hall JA, Dornan MC. What patients like about their medical care and how often they are asked: a meta-analysis of the satisfaction literature. Soc Sci Med. 1988;27:935–9.
Fennema K, Meyer DL, Owen N. Sex of physician: patients’ preferences and stereotypes. J Fam Pract. 1990;30:441–6.
PubMed Copyright information
© Society of General Internal Medicine 1994