Preventive and other interactional skills of general practitioners, surgeons, and physicians: perceived competence and endorsement of postgraduate training

Doctors as disseminators? Practicing physicians as multipliers for community-based prevention networks in a large city in western Germany

Aim

Practicing physicians have a special position as disseminators of community-based prevention for children. However, it is unclear to what extent physicians inform parents about programs. The study investigated: To what extent do physicians disseminate information about community-based prevention for children aged 0–7? Do differences exist along family’s socioeconomic position (SEP) and immigrant background?

Subject and methods

We conducted a retrospective cohort study in a German school entrance examination. Parents were invited to participate in a survey on community-based prevention with information about their awareness and information source. SEP was measured by parental education, immigrant background by country of birth. For nine services types, we counted how often parents named physicians and other professional groups as information sources. To estimate social differences, we calculated adjusted odds ratios (OR) with 95% confidence interval (CI).

Results

Survey participants included 6480 parents (response 65.49%). Compared to other information sources, physicians were mentioned less frequently. For example, regarding language therapy, 31.2% of parents were informed by healthcare/social services, and 4.4% by physicians. Lower educated parents were less frequently informed by physicians about counseling services (OR 0.58; 95% CI 0.46–0.73) compared to higher educated parents. Parents with immigrant background were informed less often about parenting skills courses (OR 0.79; 95% CI 0.70–0.90) compared to parents without immigrant background, but more often about language therapy (OR 1.47; 95% CI 1.13–1.91). No further social differences were observed.

Conclusion

The role of physicians as disseminators for community-based prevention is expandable. They should promote parenting skills courses in a socially sensitive way.

Uncovering and validating clinicians' experiential knowledge when facing difficult conversations: a cross-cultural perspective

OBJECTIVE

To explore clinicians' experiential knowledge when conducting difficult conversations; and to verify if experiential knowledge is culturally based.

METHOD

Data were collected in Italy and the United States during the Program to Enhance Relational and Communication Skills (PERCS) workshops. At the beginning of each workshop, during a whiteboard exercise, clinicians shared the strategies they had found helpful in difficult conversations. The strategies were analyzed in each country through content analysis. Upon completion of this primary analysis, the themes identified within each country were synthesized into second-order themes by means of aggregated concept analysis.

RESULTS

We conducted 14 Italian and 12 American PERCS-workshops enrolling a total of 304 clinicians. The suggestions that were similar across both countries were related to: organizational aspects and setting preparation; communication and relational skillfulness; clinician mindfulness; interpersonal qualities and sensibilities; and teamwork and care coordination. Additionally, US participants identified attention to cultural differences as a helpful strategy.

CONCLUSION

Clinicians can access relational strategies, tied to their experience, that are typically unrecognized in medical education. The whiteboard exercise is an effective teaching tool to uncover and validate already-existing relational knowledge.

PRACTICE IMPLICATIONS

Communication training programs can foster clinicians' sense of preparation by building upon their already-existing knowledge.

Can teaching agenda-setting skills to physicians improve clinical interaction quality? A controlled intervention

BACKGROUND

Physicians and medical educators have repeatedly acknowledged the inadequacy of communication skills training in the medical school curriculum and opportunities to improve these skills in practice. This study of a controlled intervention evaluates the effect of teaching practicing physicians the skill of "agenda-setting" on patients' experiences with care. The agenda-setting intervention aimed to engage clinicians in the practice of initiating patient encounters by eliciting the full set of concerns from the patient's perspective and using that information to prioritize and negotiate which clinical issues should most appropriately be dealt with and which (if any) should be deferred to a subsequent visit.

METHODS

Ten physicians from a large physician organization in California with baseline patient survey scores below the statewide 25th percentile participated in the agenda-setting intervention. Eleven physicians matched on baseline scores, geography, specialty, and practice size were selected as controls. Changes in survey summary scores from pre- and post-intervention surveys were compared between the two groups. Multilevel regression models that accounted for the clustering of patients within physicians and controlled for respondent characteristics were used to examine the effect of the intervention on survey scale scores.

RESULTS

There was statistically significant improvement in intervention physicians' ability to "explain things in a way that was easy to understand" (p = 0.02) and marginally significant improvement in the overall quality of physician-patient interactions (p = 0.08) compared to control group physicians. Changes in patients' experiences with organizational access, care coordination, and office staff interactions did not differ by experimental group.

CONCLUSION

A simple and modest behavioral training for practicing physicians has potential to positively affect physician-patient relationship interaction quality. It will be important to evaluate the effect of more extensive trainings, including those that work with physicians on a broader set of communication techniques.

Randomised trial of intensive academic detailing to promote opportunistic recruitment of women to cervical screening by general practitioners

OBJECTIVE

To evaluate a multifaceted intervention involving intensive academic detailing for general practitioners (GPs) to improve recruitment of women for cervical screening.

METHODS

We conducted a cluster randomisation trial involving 39 general practices in inner-metropolitan Sydney. GPs' knowledge, propensity to an opportunistic approach, competence and confidence were assessed by self-report before and after the intervention. To measure GP behaviour, recall of an opportunistic discussion about cervical screening was determined in cross-sectional samples of female patients at baseline (n = 1,090) and post-test (n = 1,062).

RESULTS

Knowledge improved marginally in both groups but there were no changes in other GP self-reported measures. At post-test, women attending GPs in the intervention group were no more likely than those in the control group to recall an opportunistic inquiry about their cervical screening status (OR 0.65, 95% CI 0.40-1.08). Women in the intervention group who were overdue for cervical screening were no more likely than their control group counterparts at post-test to recall advice about cervical screening (OR 2.16, 95% CI 0.75-6.14) or written information (OR 0.34, 95% CI 0.04-26.5).

CONCLUSIONS

Intensive academic detailing does not improve an opportunistic approach to cervical screening in general practice.

IMPLICATIONS FOR PUBLIC HEALTH PRACTICE

In an evidence-based climate, implementation of academic detailing as a strategy to improve cervical screening rates in general practice would be premature.

Surgeons’ Attitudes About Communicating With Patients and Their Families

CONTEXT

Surgeons face difficult communication challenges with patients and their families. There is a need for improved education in communication skills, especially in giving bad news. Understanding surgeons' attitudes is the first step in designing effective education programs.

OBJECTIVE

To determine surgeons' self-assessment of competence, rating of importance, and perceived need for training in communication skills relevant to patient care.

DESIGN

Anonymous self-report mail survey of demographic information and attitudes toward 12 patient care-related communication skills.

SETTING

San Diego County, California, a geographically distinct area of close to 3 million inhabitants receiving health care from over 6000 physicians.

PARTICIPANTS

A total of 351 (43.4%) respondents from the 833 surgical specialists in the San Diego County Medical Society list of member and nonmember physicians.

MAIN OUTCOME MEASURES

Measurement of surgeons' attitudes toward self-perceived competence, importance, need for training in the communication skills, and the influence of age, duration of practice, and surgical-specialty on attitudes.

RESULTS

Most respondents rated their competence high except in 3 skills relating to a patient's death. They found all skills important and indicated a need for training in them. Younger surgeons rated their competence and the importance significantly lower in the 3 skills relating to a patient's death (p < 0.05). Critical care surgical specialists rated their competence and the importance higher in skills relating to breaking bad news and a patient's death than did the non-critical care group (p < 0.05). Older surgeons and critical care specialists also indicated a higher level of support for training in these skills.

CONCLUSION

These results suggest that surgical specialists rate themselves as competent in effective communication, believe in its importance, and agree with the need for training. An organized approach to training in interaction skills, especially in giving bad news, is warranted.

Physician communication skills training: a review of theoretical backgrounds, objectives and skills

CONTEXT

Significant shortcomings have been noted in the literature in communication skills training for practising doctors. Given the importance of competent communication to the doctor-patient relationship and health care in general, these shortcomings should be addressed in future research.

OBJECTIVE

Research into physician communication skills training is examined with respect to the communication objectives and behaviours that are addressed.

METHODS

A Medline search of literature from 1990 to the present was conducted.

RESULTS

A total of 26 studies of doctor communication skills training were found. The majority of studies included insufficient information about the communication behaviours taught to participants. In several studies, there was a mismatch between stated behaviours and instruments or procedures used to assess them.

CONCLUSION

Three recommendations are suggested. Firstly, future researchers should take greater care in matching assessment instruments with stated communication skills. Secondly, researchers should provide and use a theoretical framework for selecting communication skills to address in interventions, and thirdly, the timing of communication skills within the interview context should be part of the instruction in interventions.