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Research papers
Medwave 2019;19(9):e7705 doi: 10.5867/medwave.2019.09.7705
Perception of medical communication skills during the clinical interview in a Peruvian teaching hospital: validation and application of an assessment tool
Rodrigo C. Quispe, Emmanuel M. Muñoz, Alvaro V. Cadillo, Ray Ticse
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Key Words: medical education, medical residency, physician-patient relations, communication

Abstract

Objective
To determine the perception of patients regarding physicians’ communication skills at the outpatient clinic of a teaching hospital in Lima-Peru, using the Communication Assessment Tool (CAT).

Methods
The study population was the group of patients treated in the outpatient clinics of the Cayetano Heredia Hospital. The CAT questionnaire contains 15 questions, and a version validated for Spanish was used. The perception of communication skills was defined as the sum of the scores of all the items, over the number of items, defined as: poor (1), fair (2), good (3), very good, (4), and excellent (5).

Results
The percentage of patients who rated communication skills as "poor" (average CAT Score) was 6.8%, "fair" 27.2%, "good" 23.9%, "very good" 30.1 and "excellent" 12.1%. Statistically significant differences were found when comparing the age ranges and among the different levels of education. The group of patients between 18 and 29 years old gave higher scores in the instrument (range 2.2 to 4.87, p = 0.001). Furthermore, when the educational level of the respondent was high, the participants tended to rate physicians with higher scores (range 3.67 to 4.73, p = 0.001).

Conclusion
We found that 66.2% of patients had a positive perception of the physicians’ communication skills; only 12.1% rated it as "excellent," a value well below what is reported in the literature. Those who gave the best rating were younger patients with the highest level of education.


 

Only Spanish version is available.

 

Licencia Creative Commons Esta obra de Medwave está bajo una licencia Creative Commons Atribución-NoComercial 3.0 Unported. Esta licencia permite el uso, distribución y reproducción del artículo en cualquier medio, siempre y cuando se otorgue el crédito correspondiente al autor del artículo y al medio en que se publica, en este caso, Medwave.

 

Objetivo
Determinar la percepción de los pacientes sobre la destreza en la comunicación de los médicos que atienden en consultorio externo de un hospital docente de Lima, Perú, según el instrumento Communication Assessment Tool.

Métodos
La población de estudio fue el colectivo de pacientes atendidos en los consultorios externos del Hospital Cayetano Heredia. El cuestionario Communication Assessment Tool consta de 15 preguntas, se utilizó una versión validada al castellano. La percepción de la destreza en comunicación se determinó como la sumatoria de los puntajes del total de las premisas, entre la cantidad de las premisas. Se definió como mala (1), justa (2), buena (3), muy buena (4) y excelente (5).

Resultados
El porcentaje de pacientes que calificaron la competencia comunicativa como “mala” (puntaje Communication Assessment Tool promedio) fue de 6,8%, “justa” 27,2%, “buena” 23,9%, “muy buena” 30,1% y “excelente” 12,1%. Se hallaron diferencias estadísticamente significativas respecto a los rangos de edad y entre los distintos grados de instrucción. El grupo de pacientes entre 18 y 29 años otorgó puntajes más altos en el Communication Assessment Tool (rango = 2,2 a 4,87; p = 0,001). Además, cuando el nivel educativo del encuestado fue superior tendió a colocar puntajes más altos (rango = 3,67 a 4,73; p = 0,001).

Conclusiones
Se determinó que 66,2% de los pacientes tuvo una percepción positiva, sólo 12,11% lo calificó como “excelente”, un valor muy por debajo a lo reportado en la literatura. Los que brindaron mejor calificación fueron los pacientes jóvenes y con mayor grado de instrucción.

Authors: Rodrigo C. Quispe[1], Emmanuel M. Muñoz[1], Alvaro V. Cadillo[1], Ray Ticse[1]

Affiliation:
[1] Facultad de Medicina Alberto Hurtado, Universidad Peruana Cayetano Heredia, Lima, Perú

E-mail: ray.ticse@upch.pe

Author address:
[1] Av. Honorio Delgado 430
Urb. Ingeniería
San Martín de Porres
Lima 31
Perú

Citation: Quispe RC, Muñoz EM, Cadillo AV, Ticse R. Perception of medical communication skills during the clinical interview in a Peruvian teaching hospital: validation and application of an assessment tool. Medwave 2019;19(9):e7705 doi: 10.5867/medwave.2019.09.7705

Submission date: 7/4/2019

Acceptance date: 2/9/2019

Publication date: 18/10/2019

Origin: not commissioned

Type of review: reviewed by three external peer reviewers, double-blind

PubMed record

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  1. Canada. RCoPaSo. CanMEDS Framework.2018; enero 2018. [on line]. | Link |
  2. Benson BJ. Domain of competence: Interpersonal and communication skills. Acad Pediatr. 2014 Mar-Apr;14(2 Suppl):S55-65. | CrossRef | PubMed |
  3. Aiarzaguena JM, Grandes G, Gaminde I, Salazar A, Sánchez A, Ariño J. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med. 2007 Feb;37(2):283-94. | PubMed |
  4. Bieber C, Müller KG, Blumenstiel K, Schneider A, Richter A, Wilke S, et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns. 2006 Nov;63(3):357-66. | PubMed |
  5. Cals JW, de Bock L, Beckers PJ, Francis NA, Hopstaken RM, Hood K, et al. Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Ann Fam Med. 2013 Mar-Apr;11(2):157-64. | CrossRef | PubMed |
  6. Girgis A, Cockburn J, Butow P, Bowman D, Schofield P, Stojanovski E, et al. Improving patient emotional functioning and psychological morbidity: evaluation of a consultation skills training program for oncologists. Patient Educ Couns. 2009 Dec;77(3):456-62. | CrossRef | PubMed |
  7. Borrell F, Sobrino A, Bosch JM, Quesada F. [25 Years of health & communication]. Aten Primaria. 2015 Jan;47(1):3-6. | CrossRef | PubMed |
  8. Cleries X. La esencia de la comunicación en educación médica. Educ Med 2010;13:25-31. | Link |
  9. Ticse R. El Examen Clínico Objetivo Estructurado (ECOE) en la evaluación de competencias de comunicación y profesionalismo en los programas de especialización en Medicina. Revista Medica Herediana. 2017;28:192-9. | Link |
  10. Klein D. Assessment of communication skills in family medicine. Can Fam Physician. 2015 Sep; 61(9): e412–e416. | Link |
  11. Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Educ Couns. 2007 Aug;67(3):333-42. | PubMed |
  12. Ferranti DE, Makoul G, Forth VE, Rauworth J, Lee J, Williams MV. Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT). J Hosp Med. 2010 Nov-Dec;5(9):522-7. | CrossRef | PubMed |
  13. Mercer LM, Tanabe P, Pang PS, Gisondi MA, Courtney DM, Engel KG, et al. Patient perspectives on communication with the medical team: pilot study using the Communication Assessment Tool-Team (CAT-T). Patient Educ Couns. 2008 Nov;73(2):220-3. | CrossRef | PubMed |
  14. Myerholtz L, Simons L, Felix S, Nguyen T, Brennan J, Rivera-Tovar A, et al. Using the communication assessment tool in family medicine residency programs. Fam Med. 2010 Sep;42(8):567-73. | PubMed |
  15. Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011;17(2):268-74. | CrossRef | PubMed |
  16. Ferreira Padilla G, Ferrández Antón T, Baleriola Júlvez J, Almeida Cabrera R. [Communication skills in the curriculum of Medical students from Spain (1990-2014): From the Primary Health Care to the Bologna Plan. A descriptive study]. Aten Primaria. 2015 Aug-Sep;47(7):399-410. | CrossRef | PubMed |
  17. Rodríguez A, Mardones F, Villarroel L. [Evaluation of a scale to assess physician-patient relations]. Rev Med Chil. 2012 Feb;140(2):176-83. | CrossRef | PubMed |
  18. Myerholtz D. Assessing Family Medicine Residents’ Communication Skills From the Patient’s Perspective: Evaluating the Communication Assessment Tool. J Grad Med Educ. 2014 Sep;6(3):495-500. | CrossRef | PubMed |
  19. Stausmire JM, Cashen CP, Myerholtz L, Buderer N. Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT). J Surg Educ. 2014;72(1):108-16. | Link |
  20. Ramos-Rodriguez C. Percepción de las relaciones médico-paciente, por parte de los usuarios externos de un departamento de medicina. An Fac med. 2008;69(1):12-6. | Link |
  21. Mendoza Cinthya R-RC, Gutiérrez Ericson. Relación médico-paciente percibida por usuarios de consultorios externos de un hospital de Lima, Perú. Horiz Med 2016; 16 (1): 14-19. | Link |
  22. Moore P, Gomez G, Kurtz S. Doctor-patient communication: one of the basic competencies, but different. Aten Primaria. 2012 Jun;44(6):358-65. | CrossRef | PubMed |
  23. Ruiz-Moral R, Pérula de Torres LA. [Validity and reliability of a tool for assessing clinical communication in consultations: the CICAA questionnaire]. Aten Primaria. 2006 Apr 15;37(6):320-4. | PubMed |
  24. Zevallos-Palacios C, Quispe R, Mongilardi N, Montori VM, Málaga G. [Patients' participation in clinical decision making as a strategy to protect their rights]. Rev Peru Med Exp Salud Publica. 2013 Apr;30(2):363-4. | PubMed |
  25. Mongilardi N, Montori V, Riveros A, Bernabé-Ortiz A, Loza J, Málaga G. Clinicians' involvement of patients in decision making. A video based comparison of their behavior in public vs. private practice. PLoS One. 2013;8(3):e58085. | CrossRef | PubMed |
  26. Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad Med. 2003 Aug;78(8):802-9. | PubMed |
  27. Valverde Bolívar FJ, Pedregal González M, Moreno Martos H, Cózar García I, Torío Durántez J. Communication with patients and the duration of family medicine consultations. Aten Primaria. 2018 Dec;50(10):621-628. | CrossRef | PubMed |
  28. Mongilardi N, Montori V, Riveros A, Bernabé-Ortiz A, Loza J, Málaga G. Clinicians' involvement of patients in decision making. A video based comparison of their behavior in public vs. private practice. PLoS One. 2013;8(3):e58085. | CrossRef | PubMed |
Canada. RCoPaSo. CanMEDS Framework.2018; enero 2018. [on line]. | Link |

Benson BJ. Domain of competence: Interpersonal and communication skills. Acad Pediatr. 2014 Mar-Apr;14(2 Suppl):S55-65. | CrossRef | PubMed |

Aiarzaguena JM, Grandes G, Gaminde I, Salazar A, Sánchez A, Ariño J. A randomized controlled clinical trial of a psychosocial and communication intervention carried out by GPs for patients with medically unexplained symptoms. Psychol Med. 2007 Feb;37(2):283-94. | PubMed |

Bieber C, Müller KG, Blumenstiel K, Schneider A, Richter A, Wilke S, et al. Long-term effects of a shared decision-making intervention on physician-patient interaction and outcome in fibromyalgia. A qualitative and quantitative 1 year follow-up of a randomized controlled trial. Patient Educ Couns. 2006 Nov;63(3):357-66. | PubMed |

Cals JW, de Bock L, Beckers PJ, Francis NA, Hopstaken RM, Hood K, et al. Enhanced communication skills and C-reactive protein point-of-care testing for respiratory tract infection: 3.5-year follow-up of a cluster randomized trial. Ann Fam Med. 2013 Mar-Apr;11(2):157-64. | CrossRef | PubMed |

Girgis A, Cockburn J, Butow P, Bowman D, Schofield P, Stojanovski E, et al. Improving patient emotional functioning and psychological morbidity: evaluation of a consultation skills training program for oncologists. Patient Educ Couns. 2009 Dec;77(3):456-62. | CrossRef | PubMed |

Borrell F, Sobrino A, Bosch JM, Quesada F. [25 Years of health & communication]. Aten Primaria. 2015 Jan;47(1):3-6. | CrossRef | PubMed |

Cleries X. La esencia de la comunicación en educación médica. Educ Med 2010;13:25-31. | Link |

Ticse R. El Examen Clínico Objetivo Estructurado (ECOE) en la evaluación de competencias de comunicación y profesionalismo en los programas de especialización en Medicina. Revista Medica Herediana. 2017;28:192-9. | Link |

Klein D. Assessment of communication skills in family medicine. Can Fam Physician. 2015 Sep; 61(9): e412–e416. | Link |

Makoul G, Krupat E, Chang CH. Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool. Patient Educ Couns. 2007 Aug;67(3):333-42. | PubMed |

Ferranti DE, Makoul G, Forth VE, Rauworth J, Lee J, Williams MV. Assessing patient perceptions of hospitalist communication skills using the Communication Assessment Tool (CAT). J Hosp Med. 2010 Nov-Dec;5(9):522-7. | CrossRef | PubMed |

Mercer LM, Tanabe P, Pang PS, Gisondi MA, Courtney DM, Engel KG, et al. Patient perspectives on communication with the medical team: pilot study using the Communication Assessment Tool-Team (CAT-T). Patient Educ Couns. 2008 Nov;73(2):220-3. | CrossRef | PubMed |

Myerholtz L, Simons L, Felix S, Nguyen T, Brennan J, Rivera-Tovar A, et al. Using the communication assessment tool in family medicine residency programs. Fam Med. 2010 Sep;42(8):567-73. | PubMed |

Sousa VD, Rojjanasrirat W. Translation, adaptation and validation of or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011;17(2):268-74. | CrossRef | PubMed |

Ferreira Padilla G, Ferrández Antón T, Baleriola Júlvez J, Almeida Cabrera R. [Communication skills in the curriculum of Medical students from Spain (1990-2014): From the Primary Health Care to the Bologna Plan. A descriptive study]. Aten Primaria. 2015 Aug-Sep;47(7):399-410. | CrossRef | PubMed |

Rodríguez A, Mardones F, Villarroel L. [Evaluation of a scale to assess physician-patient relations]. Rev Med Chil. 2012 Feb;140(2):176-83. | CrossRef | PubMed |

Myerholtz D. Assessing Family Medicine Residents’ Communication Skills From the Patient’s Perspective: Evaluating the Communication Assessment Tool. J Grad Med Educ. 2014 Sep;6(3):495-500. | CrossRef | PubMed |

Stausmire JM, Cashen CP, Myerholtz L, Buderer N. Measuring general surgery residents' communication skills from the patient's perspective using the Communication Assessment Tool (CAT). J Surg Educ. 2014;72(1):108-16. | Link |

Ramos-Rodriguez C. Percepción de las relaciones médico-paciente, por parte de los usuarios externos de un departamento de medicina. An Fac med. 2008;69(1):12-6. | Link |

Mendoza Cinthya R-RC, Gutiérrez Ericson. Relación médico-paciente percibida por usuarios de consultorios externos de un hospital de Lima, Perú. Horiz Med 2016; 16 (1): 14-19. | Link |

Moore P, Gomez G, Kurtz S. Doctor-patient communication: one of the basic competencies, but different. Aten Primaria. 2012 Jun;44(6):358-65. | CrossRef | PubMed |

Ruiz-Moral R, Pérula de Torres LA. [Validity and reliability of a tool for assessing clinical communication in consultations: the CICAA questionnaire]. Aten Primaria. 2006 Apr 15;37(6):320-4. | PubMed |

Zevallos-Palacios C, Quispe R, Mongilardi N, Montori VM, Málaga G. [Patients' participation in clinical decision making as a strategy to protect their rights]. Rev Peru Med Exp Salud Publica. 2013 Apr;30(2):363-4. | PubMed |

Mongilardi N, Montori V, Riveros A, Bernabé-Ortiz A, Loza J, Málaga G. Clinicians' involvement of patients in decision making. A video based comparison of their behavior in public vs. private practice. PLoS One. 2013;8(3):e58085. | CrossRef | PubMed |

Kurtz S, Silverman J, Benson J, Draper J. Marrying content and process in clinical method teaching: enhancing the Calgary-Cambridge guides. Acad Med. 2003 Aug;78(8):802-9. | PubMed |

Valverde Bolívar FJ, Pedregal González M, Moreno Martos H, Cózar García I, Torío Durántez J. Communication with patients and the duration of family medicine consultations. Aten Primaria. 2018 Dec;50(10):621-628. | CrossRef | PubMed |

Mongilardi N, Montori V, Riveros A, Bernabé-Ortiz A, Loza J, Málaga G. Clinicians' involvement of patients in decision making. A video based comparison of their behavior in public vs. private practice. PLoS One. 2013;8(3):e58085. | CrossRef | PubMed |