Measuring patient views of physician communication skills: Development and testing of the Communication Assessment Tool

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Abstract

Objective

Interpersonal and communication skills have been identified as a core competency that must be demonstrated by physicians. We developed and tested a tool that can be used by patients to assess the interpersonal and communication skills of physicians-in-training and physicians-in-practice.

Methods

We began by engaging in a systematic scale development process to obtain a psychometrically sound Communication Assessment Tool (CAT). This process yielded a 15-item instrument that is written at the fourth grade reading level and employs a five-point response scale, with 5 = excellent. Fourteen items focus on the physician and one targets the staff. Pilot testing established that the CAT differentiates between physicians who rated high or low on a separate satisfaction scale. We conducted a field test with physicians and patients from a variety of specialties and regions within the US to assess the feasibility of using the CAT in everyday practice.

Results

Thirty-eight physicians and 950 patients (25 patients per physician) participated in the field test. The average patient-reported mean score per physician was 4.68 across all CAT items (S.D. = 0.54, range 3.97–4.95). The average proportion of excellent scores was 76.3% (S.D. = 11.1, range 45.7–95.1%). Overall scale reliability was high (Cronbach's alpha = 0.96); alpha coefficients were uniformly high when reliability was examined per doctor.

Conclusion

The CAT is a reliable and valid instrument for measuring patient perceptions of physician performance in the area of interpersonal and communication skills. The field test demonstrated that the CAT can be successfully completed by both physicians and patients across clinical specialties. Reporting the proportion of “excellent” ratings given by patients is more useful than summarizing scores via means, which are highly skewed.

Practice implications

Specialty boards, residency programs, medical schools, and practice plans may find the CAT valuable for both collecting information and providing feedback about interpersonal and communication skills.

Introduction

Over the past decade, accreditation, certification, and quality-improvement initiatives in many countries have highlighted the importance of examining the communication skills of physicians-in-training and physicians-in-practice. In the United States, the Accreditation Council for Graduate Medical Education (ACGME) and the American Board of Medical Specialties (ABMS) jointly identified interpersonal and communication skills as one of the six general competencies for physicians [1], [2]. As noted by Duffy and colleagues, “while communication skills are the performance of specific tasks and behaviors by an individual, interpersonal skills are inherently relational and process oriented [3].” Many assessment options are available, but there is no clear guidance on how interpersonal and communication skills should be measured [3].

Patient surveys are a viable option with a long history. However, the scale development process for these surveys is often unclear and items initially developed decades ago may not seem relevant to contemporary patients. Moreover, extant instruments sometimes mix communication items with satisfaction items, bundle multiple communication elements into single items, ask patients to consider communication over a relatively long time-period (e.g., the past 12 months), or have modest internal reliability. With reliability, validity, and feasibility as central goals, we developed and tested a tool that can be used by patients to assess interpersonal and communication skills. Our objective was to create an instrument that captures patient views soon after inpatient or outpatient medical encounters, rather than impressions over a period of time. We reasoned that aggregating these “snapshots” of patient perceptions could provide specialty boards, residency programs, medical schools, and practice plans with the basis for providing focused feedback to physicians-in-practice and physicians-in-training.

Section snippets

Methods

We engaged in a systematic scale development process to obtain a psychometrically sound Communication Assessment Tool (CAT). We then conducted a field test to assess the feasibility of having physicians and patients use the CAT. Data were not connected with physician or patient names, and all aspects of the project were approved by the Northwestern University Institutional Review Board.

Results

A total of 38 of the 40 physicians (95%) were successful in completing the CAT once as a self-assessment as well as having their office staff recruit 25 patients to complete the CAT within 1 day of their visit. Accordingly, a total of 950 patients (i.e., 38 × 25) were involved in the field test (see Table 1). The patient sample included a broad range of ages, from children through patients age 75 and over. Patients sometimes had help with the CAT: 9.8% were completed by family caregivers. As one

Discussion

The 15-item Communication Assessment Tool (CAT) is a reliable and valid instrument for measuring patient perceptions of physician performance in the area of interpersonal and communication skills. Conceptually, it focuses on the achievement of communication tasks rather than prescribing particular ways of accomplishing them. At a very practical level, it is a simple and straightforward tool with discrete items that are accessible to patients across literacy levels. Moreover, the CAT can be

Acknowledgements

This study was supported by the American Board of Medical Specialties Research and Education Foundation, Evanston, Illinois, USA. Results of this research were presented at the International Conference on Communication in Healthcare (Basel, Switzerland, 2006). We thank all of the physicians, patients, and staff who participated in the development and testing process.

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