Abstract
Context:
In the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the Accreditation Council of Graduate Medical Education (ACGME) prior to graduation. Included in those core competencies are interpersonal and communication skills along with professionalism.
Objectives:
To assess strengths and weaknesses of residents’ interpersonal communication skills and professionalism in the Grandview/Southview Medical Center (Dayton, OH) osteopathic general surgery program using the validated Communication Assessment Tool (CAT).
Methods:
From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant to complete a CAT questionnaire following their encounter with a resident physician. Patients at Cassano, an outpatient office-based facility directed to the underserved local community, are seen first by an intern, then by a 4th or 5th year resident and later by an attending physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. Each resident's name was replaced on the CAT with a number for data analysis. The resident variables collected for this study included year of training, gender, and native language.
Results:
The mean response for all CAT items was 4.5 out of 5, indicating that responses to resident performance were largely positive. Patients responded to 4 of the 14 CAT items with only excellent, very good, or good responses and no fair or poor responses. Four items had only 1 fair or poor response. The remaining 6 items received more than 1 fair or poor response: “greeted me in a way that made me feel comfortable” (#1), “talked in terms I could understand” (#8), “encouraged me to ask questions” (#10), “involved me in decisions as much as I wanted” (#11), “showed care and concern” (#13), and “spent the right amount of time with me” (#14).
Conclusions:
Attending surgeons evaluate residents in multiple areas from a doctor's perspective, but there is a potential lack of correlation between that evaluation and a patient's experience, which is paramount in osteopathic medicine. Patient responses to the CAT questionnaire can be used by program directors to identify deficiencies in milestone/competency achievement and facilitate improvement both individually and programmatically for residents according to ACGME standards.
The 4 primary tenets of osteopathic medicine translate well to surgical care. First, the body's innate ability to heal allows surgical manipulation, incision, and excision of structures to promote function. In the perioperative period, including in the outpatient setting, osteopathic physicians attempt to treat the patient's mind, body, and spirit. Thinking about how pathology affects the entire patient, instead of just a patient's individual components, leads to the best care. With these ideas in mind, the osteopathic general surgery program at Grandview/Southview Medical Center in Dayton, Ohio, continues to assess its strengths and deficiencies for the sake of quality improvement, both in resident education and patient care. One component of this assessment focuses on resident performance in the Cassano General Surgery Clinic, an outpatient office-based facility. This service is directed to the underserved local community, managed by residents, and overseen by attending physicians. Patients who present to the facility are evaluated first by an intern, then by a fourth or fifth-year resident, and subsequently, an attending physician.
The Accreditation Council of Graduate Medical Education (ACGME) has instituted a method to assess resident progression through a given program. Following the transition of osteopathic programs to the single-accreditation graduate medical education (GME) system, residents are required to demonstrate skill in a set of core competencies identified by the ACGME before graduation. Skill is determined by achieving milestones in each competency, ensuring continued improvement throughout 5 years of training.
1 These core competencies translate well to previously established osteopathic principles; we continue to focus on treating the patient as an overall functional unit.
The ACGME milestones of interpersonal communication skills and professionalism are measured through the Communication Assessment Tool (CAT), which is a paper-based survey of patient perceptions of care (
Figure 1) originally developed and validated by Makoul et al.
2 The CAT was subsequently validated by other researchers, including Myerholtz et al,
3 who used it first to assess family medicine residencies in Toledo, Ohio at Mercy Saint Vincent Hospital.
3 The CAT contains 14-questions rating physician performance on a 5-point Likert-type scale, poor (1) to excellent (5). In addition, resident and patient demographics are recorded and evaluated.
In this study, we report the results of our evaluation of resident communication skills and professionalism in the outpatient setting using the CAT.
From November 2014 to June 2018, all patients who presented for an appointment at the Cassano General Surgery Clinic were asked by a medical assistant (MA) to complete a CAT questionnaire following their encounter with a resident physician. Patients 18 years of age or older were included; patients were excluded if they were unable to understand or read English. The MA informed patients that completion of the survey was voluntary and that responses were confidential. Patient demographics were collected, including age, gender, race/ethnicity, and previous exposure to this resident physician. After the patient returned the completed CAT form to the MA, it was placed in a sealed envelope. At no point were residents allowed to participate in requests to complete the CAT or in collecting CAT surveys. The resident variables collected for this study included year of training, gender, and native language. Although it was made clear to each patient by the MA's verbal description which resident was being evaluated through the CAT, names were replaced with numbers for data analysis.
Expedited approval for this prospective study was given by the institutional review board through the Kettering Health Network.
The primary investigator at the time (A.N.) collected CAT surveys for data aggregation and analysis. Data were entered into Microsoft Excel and imported into IBM SPSS Statistics for Windows, Version 24.0, (IBM Corp.) for analysis. Nominal variables were summarized with frequencies and percentages. Continuous variables were summarized with mean, standard deviation, median, and range.