Impact of supervision and self-assessment on doctor-patient communication in rural Mexico.
OBJECTIVE
To determine whether supervision and self-assessment activities can improve doctor-patient communication.


METHODS
Six supervisors, 60 doctors in their last year of training, and 232 primary health care patients at rural health clinics in Michoacan, Mexico.


METHODS
The main evaluation compared post-intervention measures in control and intervention groups. A small panel study also examined changes from baseline to post-intervention rounds in both groups.


METHODS
Over a 4-month period, specially trained supervisors added 1 hour of supervision on interpersonal communication and counseling (IPC/C) to regular site visits. Doctors, who had received prior IPC/C training, periodically audiotaped and assessed their own consultations.


METHODS
These comprised frequency of doctors' facilitative communication, doctors' biomedical information-giving, and patients' active communication.


RESULTS
The performance of all doctors improved markedly over the study period, but gains in facilitative communication and information-giving were significantly greater in the intervention than the control group. No single component of the intervention was responsible for the improvement; it resulted from the combination of activities. The doctors appreciated the more supportive relationship with supervisors that resulted from the intervention and found listening to themselves on audiotape a powerful, although initially stressful, experience.


CONCLUSIONS
Supportive supervision and self-assessment activities can reinforce IPC/C training, prompt reflection and learning, and help novice doctors improve their interpersonal communication skills.
Kim
Young-Mi
YM
Center for Communication Programs, Johns Hopkins University, School of Public Health, Baltimore, MD 21202-4012, USA. ykim@jhuccp.org
Figueroa
Maria Elena
ME
Martin
Antonieta
A
Silva
Ricardo
R
Acosta
Sixto F
SF
Hurtado
Manuel
M
Richardson
Paul
P
Kols
Adrienne
A
D003142:Communication; D035061:Control Groups; D003376:Counseling; D005260:Female; D006302:Health Services Research; D006801:Humans; D008297:Male; D008800:Mexico; D008875:Middle Aged; D010358:Patient Participation; D010817:Physician-Patient Relations; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D012647:Self-Assessment