Abstract
Objective
To determine whether patient–physician communication in obstetrics and gynaecology can be improved by a training program and to investigate if physicians with poorer performance before the training show greater improvement in communication skills scores over the course of the study.
Design
Intervention study with randomisation in training (n = 16) and control group (n = 16) and patient satisfaction and communication skills of physicians as outcome variables. Physicians’ communication skills were assessed by independent raters using a standardised evaluation instrument (adapted version of the MAAS-R) to analyse video recorded interviews before and after the training. Patient satisfaction was assessed with a patient satisfaction questionnaire.
Results
Using general linear model (GLM) for repeated measures no group × time interaction nor time effects were found for physicians’ communication skills. No group × time interaction was found for patients’ satisfaction scores; however the significant time effect was mostly attributable to positive changes in patients’ rating of the training group. Physicians with poorer performance at the beginning showed greater improvements over the course of the study, especially in the training group.
Conclusions
In this randomized controlled trial marginal intervention effects for the improvement of communication skills and only partial changes in patient satisfaction scores from pre to post training were shown. However, physicians with poorer performance at the beginning showed greater improvements, suggesting that competence levels were already relatively high at the beginning of the study. Also, formation of communication training groups should be based on specific skill deficits rather than being implemented unspecifically for an entire team of physicians.
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References
Stewart MA (1995) Effective physician–patient communication and health outcomes: a review. CMAJ 152(9):1423–1433
Levinson W, Roter DL, Mullooly JP, Dull VT, Frankel RM (1997) Physician–patient communication. The relationship with malpractice claims among primary care physicians and surgeons. JAMA 277(7):553–559
Levinson W, Chaumeton N (1999) Communication between surgeons and patients in routine office visits. Surgery 125(2):127–134
Bull SA, Hu XH, Hunkeler EM, Lee JY, Ming EE, Markson LE, Fireman B (2002) Discontinuation of use and switching of antidepressants: influence of patient–physician communication. JAMA 288(11):1403–1409
Mead N, Bower P, Hann M (2002) The impact of general practitioners’ patient-centredness on patients’ post-consultation satisfaction and enablement. Soc Sci Med 55(2):283–299
Kurtz SM (2002) Doctor–patient communication: principles and practices. Can J Neurol Sci 29(Suppl 2):S23–S29
Klass D, DeChamplain A, Fletscher E, King A, Macmillen M (1998) Development of a performance-based test of clinical skills for the United States medical license in examination. Fed Bull 85:177–185
Hargie O, Dickson D, Boohan M, Hughes K (1998) A survey of communication skills training in UK schools of medicine: present practices and prospective proposals. Med Educ 32(1):25–34
Cegala DJ, Lenzmeier Broz S (2002) Physician communication skills training: a review of theoretical backgrounds, objectives and skills. Med Educ 36(11):1004–1016
Bitzer J, Stauber M (1995) Psychosomatic obstetrics and gynecology. Monduzzi Editore Bologna
Fathalla M (1997) From obstetrics and gynecology to women’s health. Parthenon, New York
van Dulmen AM (1999) Communication during gynecological out-patient encounters. J Psychosom Obstet Gynaecol 20(3):119–126
van Dulmen AM, Bensing JM (2000) Gender differences in gynecologist communication. Women Health 30(3):49–61
van Dulmen AM, van Weert JC (2001) Effects of gynaecological education on interpersonal communication skills. BJOG 108(5):485–491
Kravitz RL, Cope DW, Bhrany V, Leake B (1994) Internal medicine patients’ expectations for care during office visits. J Gen Intern Med 9(2):75–81
Langewitz WA, Eich P, Kiss A, Wossmer B (1998) Improving communication skills—a randomized controlled behaviorally oriented intervention study for residents in internal medicine. Psychosom Med 60(3):268–276
van Thiel J, Kraan HF, Van Der Vleuten CP (1991) Reliability and feasibility of measuring medical interviewing skills: the revised Maastricht history-taking and advice checklist. Med Educ 25(3):224–229
Kraan H, Crijnen A, Van Der Vleuten CP, Imbos T (1995) Evaluation instruments for medical interviewing skills. In: Lipkin M, Putnam S, Lazare (Eds) The medical interview. Springer, New York
Branch WT Jr, Kern D, Haidet P, Weissmann P, Gracey CF, Mitchell G, Inui T (2001) The patient–physician relationship teaching the human dimensions of care in clinical settings. JAMA 286(9):1067–1074
Hutchinson L (1999) Evaluating and researching the effectiveness of educational interventions. BMJ 318(7193):1267–1269
Hulsman RL, Ros WJ, Winnubst JA, Bensing JM (1999) Teaching clinically experienced physicians communication skills. A review of evaluation studies. Med Educ 33(9):655–668
Gunn J, Southern D, Chondros P, Thomson P, Robertson K (2003) Guidelines for assessing postnatal problems: introducing evidence-based guidelines in Australian general practice. Fam Pract 20(4):382–389
Makoul G (2001) The SEGUE framework for teaching and assessing communication skills. Patient Educ Couns 45(1):23–34
Makoul G (2001) Essential elements of communication in medical encounters: the Kalamazoo consensus statement. Acad Med 76(4):390–393
Bensing J, van Dulmen S, Tates K (2003) Communication in context: new directions in communication research. Patient Educ Couns 50(1):27–32
Roter DL, Hall JA, Kern DE, Barker LR, Cole KA, Roca RP (1995) Improving physicians’ interviewing skills and reducing patients’ emotional distress. A randomized clinical trial. Arch Intern Med 155(17):1877–1884
McKinstry B (2000) Do patients wish to be involved in decision making in the consultation? A cross sectional survey with video vignettes. BMJ 321(7265):867–871
Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S (2001) Preferences of patients for patient centred approach to consultation in primary care: observational study. BMJ 322(7284):468–472
Fallowfield L (1993) Giving sad and bad news. Lancet 341(8843):476–478
Girgis A, Sanson-Fisher RW (1998) Breaking bad news 1: current best advice for clinicians. Behav Med 24(2):53–59
Little P, Everitt H, Williamson I, Warner G, Moore M, Gould C, Ferrier K, Payne S (2001) Observational study of effect of patient centredness and positive approach on outcomes of general practice consultations. BMJ 323(7318):908–911
van Dulmen S, Nubling M, Langewitz W (2003) Doctor’s responses to patients’ concerns; an exploration of communication sequences in gynaecology. Epidemiol Psichiatr Soc 12(2):98–102
Mead N, Bower P (2002) Patient-centred consultations and outcomes in primary care: a review of the literature. Patient Educ Couns 48(1):51–61
Christensen JF, Levinson W, Colligan JL, Dunn PM, Jones SR, Morgenstern A (1987) A one-day communication workshop for internal medicine residents. J Med Educ 62(8):687–690
Edwards A, Tzelepis A, Klingbeil C, Melgar T, Speece M, Schubiner H, Burack R (1996) Fifteen years of a videotape review program for internal medicine and medicine-pediatrics residents. Acad Med 71(7):744–748
Farnill D, Todisco J, Hayes SC, Bartlett D (1997) Videotaped interviewing of non-English speakers: training for medical students with volunteer clients. Med Educ 31(2):87–93
Gordon JH, Walerstein SJ, Pollack S (1996) The advanced clinical skills program in medical interviewing: a block curriculum for residents in medicine. Int J Psychiatry Med 26(4):411–429
Binder J (1997) The mental functioning and training of psychodynamic psychotherapistst. Presentation at the Conference on the training of psychotherapists’ information processing in 2000. Grindelwald
Silberschatz G, Fretter PB, Curtis JT (1986) How do interpretations influence the process of psychotherapy? J Consult Clin Psychol 54(5):646–652
Acknowledgments
The study was kindly funded by the Swiss National Fund. The funding source had no involvement in the work presented here.
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Alder, J., Christen, R., Zemp, E. et al. Communication skills training in obstetrics and gynaecology: whom should we train? A randomized controlled trial. Arch Gynecol Obstet 276, 605–612 (2007). https://doi.org/10.1007/s00404-007-0399-0
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DOI: https://doi.org/10.1007/s00404-007-0399-0