Hospital Doctors' Communication Skills : A randomized controlled trial investigating the effect of a short course and the usefulness of a patient questionnaire
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The principles of good communication between doctors and patients are well known. We also know that learner centred training improves doctors’ communication skills. Most studies have, however, been done outside of hospitals or exclusively with oncologists. We have found no large-scale studies that have investigated the effect of communication skills training using hospital doctors, from all clinical settings, trained by the same course.
In a cross-over randomized controlled trial in a large Norwegian hospital we trained doctors for two days following the didactic model of the Four Habits approach to effective clinical communication. We assessed the doctors’ communication skills using videotaped encounters with real patients from different clinical settings throughout the hospital, rating the communication skills using the Four Habits Coding Scheme. Patients were recruited using a model developed by us, using SMS after 24 hours to confirm a preliminary consent. We investigated the patients’ experiences regarding the doctors’ communication skills using the Four Habits Patient Questionnaire - a questionnaire whose content was virtually the same as the coding scheme used to score the videos.
We included 71 of 103 (69%) doctors asked and 497 of 574 (87%) patients. Doctors’ baseline communication skills were below scale midpoint. Their communication skills improved significantly when assessed with the total score of the coding scheme, and the doctors who had had prior training improved the most. However, the doctors reported it was hard to maintain the change in communication behaviour over time. 87.8% of the between-doctor variance was not detectable by the patient questionnaire.
Two days of training improved hospital doctors’ communication skills. A communication specific patient questionnaire was found to be unsuitable for the purpose of identifying doctors who had been assessed, by expert observers, as performing poorly. Following my findings I suggest that, instead of trying to identify poorly performing doctors in order to train them, all doctors should attend communication skills training sessions on a regular basis.
List of papers. Papers I-IV are removed from the thesis due to copyright restrictions.
Paper I Gulbrandsen, P. & Jensen, B. F. Post-recruitment confirmation of informed consent by SMS. Journal of medical ethics, 2010, 36, 126-8. doi:10.1136/jme.2009.033456
Paper II Fossli Jensen, B., Gulbrandsen, P., Benth, J. S., Dahl, F. A., Krupat, E. & Finset, A. Interrater reliability for the Four Habits Coding Scheme as part of a randomized controlled trial. Patient Education and Counseling, 2010, 80, 405-9. doi:10.1016/j.pec.2010.06.032
Paper III Fossli Jensen, B., Gulbrandsen, P., Dahl, F. A., Krupat, E., Frankel, R. M. & Finset, A. Effectiveness of a short course in clinical communication skills for hospital physicians: Results of a crossover randomized controlled trial (ISRCTN22153332). Patient Education and Counseling, 2010, 84, 163-9. doi:10.1016/j.pec.2010.08.028
Paper IV Fossli Jensen, B., Dahl, F. A., Safran, D. G., Garratt, A. M., Krupat, E., Finset, A. & Gulbrandsen, P. The ability of a behaviour-specific patient questionnaire to identify poorly performing doctors. BMJ quality & safety, 2011, 20, 885-93 doi:10.1136/bmjqs-2011-000021