Assessment of Emergency Medicine Residents’ Bedside Communication Skills: A Survey of Emergency Department Patients

Amanda KellerYork College of PA Biology Department

OBJECTIVE:

The objective of this study is to assess the bedside communication skills and professionalism of York Hospital Emergency Medicine (EM) residents as perceived by their patients.

INTRODUCTION:

Physician-patient communication plays a key role in patient satisfaction. Development of communication skills have become a major focus of medical schools, residency programs, and hospitals because when a patient is satisfied, they are more likely to follow post emergency department (ED) instructions, attend follow-up appointments, and take prescribed medications1,2.

Studies have been done to assess physicians’ communications skills by:

1) Evaluation of videotaped physician-patient

interactions evaluated by peers 2) Mailed surveys to patients concerning

physician-patient interactions, and 3)Patient satisfaction surveys in the Emergency

Department, (pediatric patients and their parents)1.

Videotaped evaluations enforced what is known

as the Hawthorne effect, when a person changes their behavior when they know that they are being observed. Mailed surveys make it difficult to be sure that the patient was evaluating the correct doctor and that they were able to remember the experience correctly. Patient satisfaction surveys that have been done in the Emergency Department, focused only on pediatric patients and their parents.

The York Hospital EM residents are expected to learn appropriate professional behavior and communication at the patients’ bedside as outlined by the Residency Review and Institutional Review Committees (RRC-EM) from the Accreditation Council for Graduate Medial Education (ACGME) 3. Unfortunately there are no specified evaluations given by the RRC-EM. This study will provide the institution a way to evaluate the performance of their ED residents while limiting the Hawthorne effect.

METHODS:

Inclusion criteria: All patients 18 and older and competent presenting to the Emergency Department for care will be included in this study.

Exclusion criteria: patients under age 18, non-English speaking patients, critically ill patients and patients with altered mental status or altered level of consciousness, patients whom are evaluated by medical students, non-emergency medicine residents rotating in the ED and attending physicians.

Literature Cited:1. Magaret ND, Clark TA, Warden CR, Magnusson AR, Hedges JR. (2002) Patient Satisfaction in the Emergency Department- A Survey of Pediatric Patients and Their Parents. Acad Emerg Med., Dec; 9(12): 1379-1388.2. Report III Contemporary Issues in Medicine: Communication in Medicine: Medical School Objectives Project. October 1999. Association of American Medical Colleges.3. ACGME: Outcome Project General Competencies. www.acgme.org/outcome/comp/compFull.asp

RESULTS

Acknowledgment: Dr. Nolan, Dr. Kaltreider, Amy Daugherty, MS, Marc Pollack, MD, PhD andRonald Benenson, MD

Approach Patient

Receive Verbal Consent

Have Patient Identify their Resident from

pictures

Have patient fill out evaluation•148 patients were surveyed•30 residents were evaluated

•8 1st year residents•11 2nd year residents•11 3rd year residents

Average of 4.9 surveys per resident

Perform statistical tests

Spearman Correlation

Descriptive Statistics

http://images.google.com/url?q=http://www.musc.edu/hrm/benefits/ins_medical.htm&usg=__iht4DReaQuPHWmimF8U30JMKmF4= http://www.girlshealth.gov/disability/changingdr.htm

CONCLUSION:

• Real time patient evaluations of residents’ bedside manner is a promising tool that provides information for constructive resident feedback, changes in residency educational content and data for a 360o evaluation of core competencies.

• Future studies would evaluate the effectiveness and reliability of evaluations given at the bedside by comparing different residency programs at York Hospital or ED residents at a separate location.

Table 1: Evaluation of Residents communication skills and bedside manner.

Question Yes/Yes Completely

Yes Somewhat

No Other

Did your Doctor (Dr.) Introduce Him/herself?

97.3 - .7 2.0

Did your Dr. introduce him/herself to your family if present?

62.2 - 11.5 26.3

Did you know your Dr. was a resident?

51.4 - 48.6 -

Did your Dr. listen carefully w/o interrupting?

93.9 4.7 1.4 -

Did your Dr. ask questions about your problem?

98.0 - 1.4 .7

Did your Dr. ask you if you had any questions?

83.0 - 6.8 10.2

Did your Dr. answer your questions in a way you could understand?

84.9 3.4 1.4 10.3

Do you believe your doctor understood your medical problem?

84.9 14.4 .7 -

If you are having pain, did your Dr. discuss and/or offer treatment for your pain?

63.9 - 3.4 32.7

Did the Dr. talk about you as if you were not there?

3.4 - 93.9 2.7

Did the Dr. explain things about your care or tests in a way you could understand?

88.4 7.5 3.4 .7

Was your Dr. supportive of your needs while you were in the ED?

96.6 - 1.4 2.1

Did your Dr. treat you with respect?

98.6 1.4 - -

Do you feel that your Dr. spent enough time with you, discussing your concerns/problems?

87.2 10.8 2.0 -

Did you have confidence and trust in the Dr. who cared for you?

89.1 7.5 3.4 -

1. 2. 3. 4. 5. 6. 7. 8. 9. 10.0

10

20

30

40

50

60

70

80

90

Overall Rating 0-10

% o

f S

urv

ey

s

Figure 1: Overall satisfaction of patients with their Residents communication skills and professionalism in the Emergency Department. The mean overall rating of communication skills and professionalism on a scale of 0-10, with zero as the lowest score was 9.19 (± S.D. 1.35).

Figure 2: Spearman Correlation between overall patient evaluations and individual questions. Only significant correlations are shown.

http://www.sagetechs.com/projects/yorkhospital/index.html

Did you have confidence and trustin the Dr. who cared for you?

0123456789

10

YesCompletely

Yes Somewhat

No

r=0.4426p=0.0001

Ove

rall

Pat

ien

tS

atis

fact

ion

Did your know your Dr. was a resident?

0123456789

10

YesNo

r=0.2495p=0.0022

Ove

rall

Pat

ien

tS

atis

fact

ion

Did your Dr. Listen without interupting?

0123456789

10

YesCompletely

Yes Somewhat

No

r=0.2487p=0.0023

Ove

rall

Pat

ien

tS

atis

fact

ion

Did your Dr. Answer your questions in away you could understand?

0123456789

10

YesCompletely

YesSomewhat

No

r=0.3034p=0.0004

Ove

rall

Pat

ien

tS

atis

fact

ion

Was your Dr. supportive of your needswhile you were in the ED?

0123456789

10

YesNo

r=0.1906p=0.0216

Ove

rall

Pat

ien

tS

atis

fact

ion

Did the Dr. explain things about yourcare or test in a way you could understand?

0123456789

10

Yes Completely

YesSomewhat

No

r=0.3525p=0.0001

Ove

rall

Pat

ien

tS

atis

fact

ion

Do you feel that your Dr. spent enough time with youdiscussing your concerns/problems?

0123456789

10

YesCompletely

YesSomewhat

No

r=0.3536p=0.0001

Ove

rall

Pat

ien

tS

atis

fact

ion

Did your Dr. ask you if you hadany questions?

0123456789

10

YesNo

r=0.3693p=0.0001

Ove

rall

Pat

ien

tS

atis

fact

ion

Do you believe your Dr. understoodyour medical problem?

0123456789

10

YesCompletely

Yes Somewhat

No

r=0.4457p=0.0001

Ove

rall

Pat

ien

tS

atis

fact

ion