The Evaluation of Physicians' Communication Skills From Multiple Perspectives
The Evaluation of Physicians' Communication Skills From Multiple Perspectives
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DOI：
10.1370/afm.2241
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发表时间：
2018-07-01
影响因子：
4.4
通讯作者：
Roland, Martin
中科院分区：
文献类型：
--
作者：
Burt, Jenni;Abel, Gary;Roland, Martin
目的：通过对个体预约的分析，比较家庭医生、患者和经过培训的临床评分员对医患沟通的评估。方法分析来自英国13家诊所45名家庭医生面对面预约的患者的调查数据。预约后立即由患者和医生独立完成一份包括7个项目的沟通质量评估问卷。由训练有素的临床评分员对预约录像样本进行评估，使用相同的7个沟通项目。使用相关系数比较患者、医生和评分者的沟通得分。结果共纳入503对医患配对；其中，55个预约也由训练有素的临床评分员进行评估。医生给自己的平均得分低于病人（医生平均得分74.5分，病人平均得分94.4分）；63.4%（319例）患者报告的评分最高为100分。55次预约的评分者平均得分为57.3分。医生报告的沟通得分与患者报告的沟通得分之间的相关系数接近于零（0.009,P =.854），医生报告的沟通得分与训练过的评分者报告的沟通得分之间的相关系数为-0.006,P =.69)。然而，患者评分与训练评分者评分之间存在中度且有统计学意义的关联（0.35,P = 0.042）。结论：医生的评分与其他人的评分之间缺乏相关性，表明医生对预约过程中良好沟通的看法可能与外部同行评分者和患者的看法不同。医生可能不知道患者是如何体验他们的沟通实践的；对沟通技巧进行同行评估是确定需要改进的领域的重要方法。
PURPOSE To examine how family physicians', patients', and trained clinical raters' assessments of physician-patient communication compare by analysis of individual appointments.METHODS Analysis of survey data from patients attending face-to-face appointments with 45 family physicians at 13 practices in England. Immediately postappointment, patients and physicians independently completed a questionnaire including 7 items assessing communication quality. A sample of videotaped appointments was assessed by trained clinical raters, using the same 7 communication items. Patient, physician, and rater communication scores were compared using correlation coefficients.RESULTS Included were 503 physician-patient pairs; of those, 55 appointments were also evaluated by trained clinical raters. Physicians scored themselves, on average, lower than patients (mean physician score 74.5; mean patient score 94.4); 63.4% (319) of patient-reported scores were the maximum of 100. The mean of rater scores from 55 appointments was 57.3. There was a near-zero correlation coefficient between physician-reported and patient-reported communication scores (0.009, P =.854), and between physician-reported and trained raterreported communication scores (-0.006, P =.69). There was a moderate and statistically significant association, however, between patient and trained-rater scores (0.35, P =.042).CONCLUSIONS The lack of correlation between physician scores and those of others indicates that physicians' perceptions of good communication during their appointments may differ from those of external peer raters and patients. Physicians may not be aware of how patients experience their communication practices; peer assessment of communication skills is an important approach in identifying areas for improvement.