Can standardized patients predict real‐patient satisfaction with the doctor‐patient relationship?

Tamblyn, Robyn; Schnarch, Brian; Abrahamowicz, Michal; Colliver, Jerry A.; Benaroya, S.; Snell, Linda

doi:10.1080/10401339409539641

Cited by 30 publications

(25 citation statements)

References 31 publications

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“…It is also noteworthy that Blue et al did not find significant correlations between the SP ABIM scores and three of the four medical interviewing skills rated by faculty. Earlier research (Tamblyn et al, 1994) demonstrated that ratings from SPs and real patients are not interchangeable.…”

Section: Discussionmentioning

confidence: 98%

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The Relationship between Checklist Scores on a Communication OSCE and Analogue Patients’ Perceptions of Communication

Mazor

Ockene

Rogers

et al. 2005

Adv Health Sci Educ Theory Pract

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Many efforts to teach and evaluate physician-patient communication are based on two assumptions: first, that communication can be conceptualized as consisting of specific observable behaviors, and second, that physicians who exhibit certain behaviors are more effective in communicating with patients. These assumptions are usually implicit, and are seldom tested. The purpose of this study was to investigate whether specific communication behaviors are positively related to patients' perceptions of effective communication. Trained raters used a checklist to record the presence or absence of specific communication behaviors in 100 encounters in a communication Objective Structured Clinical Examination (OSCE). Lay volunteers served as analogue patients and rated communication during each encounter. Correlations between checklist scores and analogue patients' ratings were not significantly different from zero for four of five OSCE cases studied. Within each case, certain communication behaviors did appear to be related to patients' ratings, but the critical behaviors were not consistent across cases. We conclude that scores from OSCE communication checklists may not predict patients' perceptions of communication. Determinants of patient perceptions of physician communication may be more subtle, more complex, and more case-specific than we were able to capture with the current checklist.

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Section: Discussionmentioning

confidence: 98%

“…The use of multiple raters reduces the impact of inter-patient variability, and thereby increases the reliability of scores. The fact that the reliability of patient ratings increases sharply as the number of patients increases is well documented (Woolliscroft et al, 1994;Wensing et al, 1997;Tamblyn et al, 1994).…”

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confidence: 95%

The Relationship between Checklist Scores on a Communication OSCE and Analogue Patients’ Perceptions of Communication

Mazor

Ockene

Rogers

et al. 2005

Adv Health Sci Educ Theory Pract

View full text Add to dashboard Cite

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Section: Discussionmentioning

confidence: 99%

“…These correlations, using a sample of community physicians, are somewhat lower than those observed in a similarly designed study of 26 Canadian resident physicians. 31 In that study, an adjusted correlation of 0.51 was observed between standardized patient and real patient ratings using the American Board of Internal Medicine satisfaction scale.The HCCQ data were obtained after the standardized patient encounter and before the real patient encounter, whereas the PPPC data were obtained after the encounter for both standardized and real patients. Despite these methods differences, the results for the HCCQ and PPPC closely parallel each other.…”

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confidence: 99%

“…Their perceptions are relatively unencumbered by prior experience with the physician, sense of indebtedness, or personal investment. They have no agendas or specifi c expectations for the visit that might affect their ratings.Others have suggested that standardized patients are a feasible and practical means for assessing physician performance, 13,19,31,34,35 although these suggestions are based on standardized patient assessment of specifi c behaviors rather than global impressions. In either case, however, their use requires considerable efforts to avoid detection by physicians, including surreptitious collaboration with offi ce staff.…”

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confidence: 99%

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Ratings of Physician Communication by Real and Standardized Patients

Fiscella¹,

Franks²,

Srinivasan³

et al. 2007

The Annals of Family Medicine

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PURPOSE Patient ratings of physician's patient-centered communication are used by various specialty credentialing organizations and managed care organizations as a measure of physician communication skills. We wanted to compare ratings by real patients with ratings by standardized patients of physician communication. METHODSWe assessed physician communication using a modifi ed version of the Health Care Climate Questionnaire (HCCQ) among a sample of 100 community physicians. The HCCQ measures physician autonomy support, a key dimension in patient-centered communication. For each physician, the questionnaire was completed by roughly 49 real patients and 2 unannounced standardized patients. Standardized patients portrayed 2 roles: gastroesophageal disorder refl ux symptoms and poorly characterized chest pain with multiple unexplained symptoms. We compared the distribution, reliability, and physician rank derived from using real and standardized patients after adjusting for patient, physician, and standardized patient effects.RESULTS There were real and standardized patient ratings for 96 of the 100 physicians. Compared with standardized patient scores, real-patient-derived HCCQ scores were higher (mean 22.0 vs 17.2), standard deviations were lower (3.1 vs 4.9), and ranges were similar (both 5-25). Calculated real patient reliability, given 49 ratings per physician, was 0.78 (95% confi dence interval [CI], 0.71-0.84) compared with the standardized patient reliability of 0.57 (95% CI, 0.39-0.73), given 2 ratings per physician. Spearman rank correlation between mean real patient and standardized patient scores was positive but small to moderate in magnitude, 0.28. CONCLUSION INTRODUCTIONP atient-centered care is a core dimension of health care quality, and strong communication skills are required to ensure such care.1 Yet, policy makers and researchers do not know how best to measure these physician communication skills.2 Because patient ratings of physician communication from surveys have face validity and are readily available, they are widely used by such organizations as the American Board of Internal Medicine and various managed care organizations.3 These ratings may eventually be used for specialty recredentialing and to determine physician bonus payments.Patient ratings of physicians are subject to a number of limitations, however. These limitations include potential biases from survey nonresponse, patient selection (and deselection) of the physician, patient accommodation to the physician's style with time, 4 length of relationship, different patient complaints, and ceiling effects. 5 Patients also respond in a global manner when rating their physicians, with high correlations among scales measuring Kevin Fiscella, MD Standardized patients-persons trained to portray a specifi c patient case in a standardized fashion 8 -represent a potentially more objective means for assessment of physician communication. Standardized patients can be trained to rate physician-patient communications skills reliably 9...

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