Objective: To assess the effects of a communication skills training program for physicians and patients. Design: A randomized experiment to improve physician communication skills was assessed 1 and 6 months after a training intervention; patient training to be active participants was assessed after 1 month. Across three primary medical care settings, 156 physicians treating 2,196 patients were randomly assigned to control group or one of three conditions (physician, patient, or both trained). Main Outcome Measures: Patient satisfaction and perceptions of choice, decision-making, information, and lifestyle counseling; physicians' satisfaction and stress; and global ratings of the communication process. Results:The following significant ( p Ͻ .05) effects emerged: physician training improved patients' satisfaction with information and overall care; increased willingness to recommend the physician; increased physicians' counseling (as reported by patients) about weight loss, exercise, and quitting smoking and alcohol; increased physician satisfaction with physical exam detail; increased independent ratings of physicians' sensitive, connected communication with their patients, and decreased physician satisfaction with interpersonal aspects of professional life. Patient training improved physicians' satisfaction with data collection; if only physician or patient was trained, physician stress increased and physician satisfaction decreased. Conclusion: Implications for improving physician-patient relationship outcomes through communication skills training are discussed.
BACKGROUND: Systems of undergraduate medical education and patient care can create barriers to fostering caring attitudes.
OBJECTIVE:The aim of this study is to survey associate deans and curriculum leaders about teaching and assessment of caring attitudes in their medical schools.
PARTICIPANTS:The participants of this study include 134 leaders of medical education in the USA and Canada.
METHODS
RESULTS:We received 73 responses from 134 medical schools. Most respondents believed that their schools strongly emphasized caring attitudes. At the same time, 35% thought caring attitudes were emphasized less than scientific knowledge. Frequently used methods to teach caring attitudes included small-group discussion and didactics in the preclinical years, role modeling and mentoring in the clinical years, and skills training with feedback throughout all years. Barriers to fostering caring attitudes included time and productivity pressures and lack of faculty development. Respondents with supportive learning environments were more likely to screen applicants' caring attitudes, encourage collaborative learning, give humanism awards to faculty, and provide faculty development that emphasized teaching of caring attitudes.
CONCLUSIONS:The majority of educational leaders value caring attitudes, but overall, educational systems inconsistently foster them. Schools may facilitate caring learning environments by providing faculty development and support, by assessing students and applicants for caring attitudes, and by encouraging collaboration.
In 1998, some 179,000 women in the United States were newly diagnosed with breast cancer, and 48,500 women died from it. Early detection by mammography, physical examination, and breast self-examination improves survival rates and can decrease mortality. The clinician's level of comfort with discussing education and prevention with patients can influence patients' adherence to preventive measures. Improved clinician-patient interpersonal communication has a demonstrated positive impact on adherence and health outcomes. We developed and pilot tested a core curriculum on breast health aimed at primary care community physicians and resident house staff. The goal was to improve interpersonal communication between clinician and patient. Two groups of participants attended either a week-long or a 2-week-long training program consisting of four components: a brief demonstration of an interview and breast examination, interviews and breast examinations with a standardized patient, and two separate workshops of varying length. This pilot program had a significant impact on clinician behavior and knowledge. We recommend further investigation of this area with larger sample sizes.
We thank David Gullen, MD for reviewing a portion of a draft of this work. We particularly thank all the future-trainers who have undergone the program for their participation, feedback, and inspiration to continue building this work.
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