Background: As our healthcare system shifts towards a patient satisfaction model, programs focusing on improving physician communication skills have been on the rise. Many of these programs have focused on outpatient providers as it can be more difficult to capture provider-patient communication in the inpatient setting. Most of the patient feedback obtained for inpatient providers comes from the HCAHPS survey which can be affected by low survey completion rates, patient memory recall, and lack of specificity for one inpatient provider (1). UW Health Patient and Family Experience (Madison, Wisconsin) has developed the Communication Advisor Program (CAP), consisting of 25 former patients and family members who have received formal training in observing and providing feedback to healthcare providers on their communication skills.
Purpose: The Internal Medicine residents at University of Wisconsin receive patient feedback in the outpatient setting, but there was not a formal way for them to receive inpatient feedback. The Communication Advisor Program was therefore implemented within the residency to allow for evaluation and feedback of the residents during their inpatient General Medicine rotation.
Description: From 10/8/2018 to 6/14/2019, the pilot was conducted involving 20 CAP volunteers and 35 PGY2 and PGY3 Internal Medicine residents, during which 119 patient communication observations were conducted. The CAP volunteer would obtain consent from the patient prior to the observation, observe the interaction between the patient and the resident, administer the Communication Assessment Tool (CAT) (2) to the patient, and then provide written feedback to the resident. The feedback consisted of both observations and suggestions for improvement from the CAP observer, and also the feedback from the patient if they had completed the CAT survey. 13 (10.9%) of the patients completed the CAT survey, and the combined resident top box rating of “excellent” ranged from 53.8%-92.3% on 14 different CAT items. The CAP observer feedback consisted of comments on the residents’ many communication strengths and also critical feedback – examples being decreasing the use of jargon, being aware of one’s physical presence in the patient encounter, increasing the use of shared decision making, and addressing mental health concerns more thoroughly. 31 senior residents were surveyed about the usefulness of this program from a resident perspective – 12 (38.7%) completed the survey. 50% of the residents found the observation experience helpful, and 42% felt they received feedback that would improve their communication style in the future. 9 residents provided examples of what they learned from this experience, and 11 gave suggestions for improvement of the program.
Conclusions: Overall, this was considered a successful pilot, and is in the process of being expanded to include all of the Internal Medicine residents (PGY1-PGY3) on their General Medicine inpatient rotations beginning in October 2019. The CAT survey tool was found to have some redundancies, and the Communication Advisor Program is now utilizing the Consultation and Relational Empathy (CARE) survey (3) which is considered simpler for the patients to complete. Due to the success of the program, there is definite interest to expand this program to include the Hospital Medicine Division, and other residency programs as well.