Journal Watch—August 2016

| August 1, 2016

A quick look at the noteworthy articles in bariatric and metabolic research


Assessing communication skills in the healthcare setting

Assessing effective physician-patient communication skills: “Are you listening to me, doc?”

Berman AC, Chutka DS. Korean J Med Educ. 2016;28(2):243–249. Epub 2016 Feb 25.
Synopsis: In this article, the authors discuss communication skills in forming the foundation for a more positive patient-provider relationship. They discuss the use of an interview assessment tool developed have developed an interview assessment tool that they use with medical students at their facility. The rubric is presented to students prior to their initial interview experience in order to provide them with the aculty members’ expectations for effective communication skills and patient-centered interviews. The rubric contains the following categories:
• Introduction
• Eye contact with patient
• Nonverbal communication
• Listening
• Questions
• Wait-time
• Concern
• Organization
• Information gathering
• Focus, Empathy
• Awareness of unspoken issues
• Closure

The authors concluded that this rubric can be effective in helping physicians become comfortable with the use of patient-centered interviews, and that in order for providers to develop positive relationships with their patients, it is important for them to practice their communication skills with the assistance of an appropriate assessment tool.
PMID: 26913771

Interprofessional training enhances collaboration between nursing and medical students: A pilot study.
Turrentine FE, Rose KM, Hanks JB, et al. Nurse Educ Today. 2016;40:33–38. Epub 2016 Feb 4.

Synopsis: To enhance interprofessional education between nursing students and medical students in a clinical environment, the authors modeled the desired behavior and skills needed for interprofessional preoperative geriatric assessment for students, then provided an opportunity for students to practice skills in nurse/physician pairs on standardized patients. This experience culminated with students performing skills independently in a clinic setting.

Nine nursing students and six medical students completed the pilot project. At baseline and after the final clinic visit we administered a ten question geriatric assessment test. Post-test scores (M=90.33, SD=11.09) were significantly higher than pre-test scores (M=72.33, SD=12.66, t(14)=-4.50, p

The authors found that having nursing and medical students “learn about, from and with each other” while conducting a preoperative geriatric assessment offered a unique collaborative educational experience for students that better prepares them to integrate into interdisciplinary clinic teams.
PMID: 27125147

The “Handling” of power in the physician-patient encounter: perceptions from experienced physicians.

Nimmon L, Stenfors-Hayes T. BMC Med Educ. 2016 Apr 18;16:114.

Synopsis: This study explored how power is perceived and exerted in the physician-patient encounter from the perspective of experienced physicians.
Thirty physicians with a minimum five years’ experience practicing medicine in the disciplines of Internal Medicine, Surgery, Pediatrics, Psychiatry, and Family Medicine were recruited. The authors analyzed semi-structured interview data using LeCompte and Schensul’s three stage process: Item analysis, Pattern analysis, and Structural analysis. Theoretical notions from Bourdieu’s social theory served as analytic tools for achieving an understanding of physicians’ perceptions of power in their interactions with patients.

The analysis of data highlighted a range of descriptions and interpretations of relational power. Physicians’ responses fell under three broad categories: 1) Perceptions of holding and managing power, 2) Perceptions of power as waning, and 3) Perceptions of power as non-existent or irrelevant.

The authors concluded that although the “sharing of power” is an overarching goal of modern patient-centered healthcare, this study highlights how this concept does not fully capture the complex ways experienced physicians perceive, invoke, and redress power in the clinical encounter. Based on the insights, the authors suggest that physicians learn to enact ethical patient-centered therapeutic communication through reflective, effective, and professional use of power in clinical encounters.
PMID: 27091146

Communication in healthcare: a narrative review of the literature and practical recommendations.

Vermeir P, Vandijck D, Degroote S, et al. Int J Clin Pract. 2015;69(11):1257-67. Epub 2015 Jul 6.

Synopsis: In this article, the researchers review the literature on the quality of written communication, the impact of communication inefficiencies, and recommendations to improve written communication in healthcare.

A search was carried out on the databases PubMed, Web of Science and The Cochrane Library by means of the (MeSH)terms ‘communication’, ‘primary health care’, ‘correspondence’, ‘patient safety’, ‘patient handoff’ and ‘continuity of patient care’. Reviewers screened 4,609 records and 462 full texts were checked according following inclusion criteria: 1) publication between January 1985 and March 2014, 2) availability as full text in English, 3) categorisation as original research, reviews, meta-analyses or letters to the editor.

A total of 69 articles were included in this review. The researchers found that poor communication can lead to various negative outcomes: discontinuity of care, compromise of patient safety, patient dissatisfaction and inefficient use of valuable resources, both in unnecessary investigations and physician worktime as well as economic consequences.

They concluded that there is room for improvement of both content and timeliness of written communication. The delineation of ownership of the communication process should be clear. Peer review, process indicators and follow-up tools are required to measure the impact of quality improvement initiatives. Communication between caregivers should feature more prominently in graduate and postgraduate training, to become engraved as an essential skill and quality characteristic of each caregiver.
PMID: 26147310

‘Becoming a Physician’-medical students get acquainted with disadvantaged populations, and practise sensitive and effective communication.

Riskin A, Kerem NC, Van-Raalte R, et al. Perspect Med Educ. 2015 Oct 19. [Epub ahead of print]

Synopsis: The authors discuss the three-year pre-medical program titled, “Becoming a Physician.” The program focuses on different aspects of medical professionalism, helping students to increase awareness and sensitivity to disadvantaged populations, and practice sensitive effective communication skills.

The curriculum includes: 1) Visits to treatment centres for people with special needs, mental illnesses, substance abuse issues, physically or sexually abused, and prisoners. Students tour the facility, hold discussions with residents, and discuss ethical professional interrelations to the medical world. Students then write ‘reflective diaries’ summarizing their thoughts and emotions. 2) Participation in a communication course that focuses on learning by practising patient-oriented communication. Qualitative data were collected from three sources: reflective diaries, students’ course evaluations, and interviews with the students’ tutors.

Data indicated that the students were very satisfied with the programme. They indicated an increase in awareness of the special needs of diverse populations, and in the sense of efficacy for conducting interviews tailored to patients’ needs. Tutors reported a sense of ‘personal growth’ following their role as mentors.

The authors concluded that interactions of medical students with diverse populations, when accompanied by appropriate feedback mechanisms and strengthening of communication skills, can improve awareness and sensitivity to patients’ special needs. This could help students become more sensitive and thoughtful physicians.
PMID: 26481394

When patients and surgeons disagree about surgical outcome: investigating patient factors and chart note communication.

Schwartz CE, Ayandeh A, Finkelstein JA. Health Qual Life Outcomes. 2015 Sep 29;13:161.

Synopsis: The authors aimed to investigate indirect effects of physician-patient communication by examining the relationship between a physician-patient mismatch in perceived outcomes and content in the medical record’s clinical note. They compared patient records whose perceived subjective assessment of surgery outcomes agreed or disagreed with the surgeon’s perception of that outcome (Subjective Disagreement).

This study included 172 spine surgery patients at a teaching hospital. Patient-reported outcomes included the Oswestry Disability Index; the Short-Form 36; and a Visual Analogue Scale items for leg and back pain. The authors content-analyzed the clinical note in the medical record, and used logistic regression to evaluate predictors of Subjective Disagreement (n = 41 disagreed vs. 131 agreed).

Patient and surgeon agreed in 76% of cases and disagreed in 24% of cases. Patients who assessed their outcome worse than their surgeons tended to be less educated and involved in litigation. They also tended to report worsened mental health and leg pain. Content analysis revealed group differences in surgeon communication patterns in the chart notes related to how symptom change was emphasized, how follow-up was described, and a specific word reference. Specifically, disagreement was predicted by using “much” to emphasize the findings and noting long-term prognosis. Agreement was predicted by use of positive emphasis terms, having an “as-needed” follow-up plan, and using “happy” in the chart note.

The nature of measuring outcomes of surgery is based on patient perception. In surgeon-patient perspective mismatches, patient factors may serve as barriers to improvement. Worsened change on patient-reported mental health may be an independent factor which colors the patient’s general perceptions. This aspect of treatment may be missed by the spine surgeon. Chart note communication styles reflect the subjective disagreement. Investigating and/ or treating mental health deterioration may be valuable in resolving this mismatch and for overall outcome.
PMID: 26416031

Category: Journal Watch, Past Articles

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