Improving Pediatric Communication Skills Using Parent Surveys
John Co, MD, MPH, MassGeneral Hospital for Children
Susan Edgman-Levitan, PA, John D. Stoeckle Center for Primary Care Innovation
Elizabeth Rider, MSW, MD, Harvard Medical School, Boston, Massachusetts
Introduction
An increasing emphasis on physician-patient communication skills is evident at all stages of physician development. COMSEP, a national organization that champions the cause of pediatric medical student education, stresses the importance of developing communication skills in clinical interaction with children, adolescents, and their families. The Accreditation Council for Graduate Medical Education (ACGME) includes interpersonal and communication skills as one of their six core competencies for assessing resident performance. Finally, the American Board of Pediatrics’ (ABP) new program for maintenance in certification in general pediatrics includes peer and patient surveys to solicit information about practitioners’ interpersonal and communications skills. Clearly, valid methods to teach, assess, and maintain communication skills are necessary at all levels of medical education.
Patient reports of care are cited by the Institute of Medicine (IOM) as an important dimension of quality of care, one that needs to be included in the National Healthcare Quality Report developed by the Agency for Healthcare Research and Quality (AHRQ) annually starting in 2003. A recent IOM report highlights the adverse effects that poorly structured health care systems can have, and suggests the use of patient reports for redesigning in-hospital processes. Interactions and processes of care that are more patient-centered have been associated with improved patient adherence to therapy and health outcomes. Finding ways to use patient reports to improve physician communication and clinical skills in treating both children and adults would be valuable both for medical education and improving quality of care.
Statement of the problem
• Communication and clinical skills development efforts in medical education almost exclusively focus on those needed for medical encounters with adults.
• Medical encounters with children differ from those with adults in several ways, including
Ø differing levels of development of children of different ages
Ø dependency of younger children on their caregivers for reporting their health concerns and medical decision-making.
• These differences should be accounted for in assessing pediatric care giving skills
Program Objective
To improve pediatric resident and medical student communication skills in pediatric encounters by obtaining parent reports of care at the time of hospital discharge.
Description of the project
Setting
This project will take place on the Massachusetts General
Hospital (MGH) pediatric inpatient units.
Patient care providers that will be eligible for communication and clinical skills assessment include:
Design of Parent Survey
We conducted a review of existing communication skills literature and assessment tools. Resources reviewed included:
• The American Board of Internal Medicine (ABIM) Patient Assessment Form
• The Pediatric Inpatient Survey
• The Kalamazoo Consensus Statement
Using these instruments, we designed items for our parent survey that would measure both individual and team performance in communication. Sample items include:
“How often did your doctor explain things in a way you could understand?”
“How often did your doctor show respect for what you had to say?”
Items for demographics of the child and family were also included:
Child Severity of Illness
Ethnicity
Primary Language Spoken at Home
Parent Educational Level
Demographic and severity of illness measures are important to collect as they have been shown to be associated with patient ratings of care.
Findings to Date and Key Lessons
• Parent survey administration must be integrated into existing workflow
• Initial survey length (35 items) too long for discharge survey
• Survey must be translated into multiple languages to provide more complete assessment of communication skills
• Timing and nature of feedback could be problematic if residents and students rotate for periods of time not long enough to obtain feedback from adequate numbers of patients
Questions
• What is the “right” number of completed patient surveys to have before generating an individual level report?
• What is the best way to deliver feedback for improvement?
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