title: Pretraining and posttraining assessment of residents' performance in the fourth accreditation council for graduate medical education competency: patient communication skills.
abstract: OBJECTIVE
  Structured communication curricula will improve surgical residents' ability to communicate effectively with patients.
  
  
  METHODS
  A prospective study approved by the institutional review board involved 44 University of Connecticut general surgery residents. Residents initially completed a written baseline survey to assess general communication skills awareness. In step 1 of the study, residents were randomized to 1 of 2 simulations using standardized patient instructors to mimic patients receiving a diagnosis of either breast or rectal cancer. The standardized patient instructors scored residents' communication skills using a case-specific content checklist and Master Interview Rating Scale. In step 2 of the study, residents attended a 3-part interactive program that comprised (1) principles of patient communication; (2) experiences of a surgeon (role as physician, patient, and patient's spouse); and (3) role-playing (3-resident groups played patient, physician, and observer roles and rated their own performance). In step 3, residents were retested as in step 1, using a crossover case design. Scores were analyzed using Wilcoxon signed rank test with a Bonferroni correction.
  
  
  RESULTS
  Case-specific performance improved significantly, from a pretest content checklist median score of 8.5 (65%) to a posttest median of 11.0 (84%) (P = .005 by Wilcoxon signed rank test for paired ordinal data)(n = 44). Median Master Interview Rating Scale scores changed from 58.0 before testing (P = .10) to 61.5 after testing (P = .94). Difference between overall rectal cancer scores and breast cancer scores also were not significant.
  
  
  CONCLUSIONS
  Patient communication skills need to be taught as part of residency training. With limited training, case-specific skills (herein, involving patients with cancer) are likely to improve more than general communication skills.
authors.affiliation: Division of Plastic Surgery, University of Connecticut Health Center, Farmington, CT 06030, USA. Chandawarkar@uchc.edu
authors.forename: Rajiv Y
authors.initials: RY
authors.lastname: Chandawarkar
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Ruscher
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Krajewski
authors.forename: Manish
authors.initials: M
authors.lastname: Garg
authors.forename: Carol
authors.initials: C
authors.lastname: Pfeiffer
authors.forename: Rekha
authors.initials: R
authors.lastname: Singh
authors.forename: Walter E
authors.initials: WE
authors.lastname: Longo
authors.forename: Robert A
authors.initials: RA
authors.lastname: Kozol
authors.forename: Beth
authors.initials: B
authors.lastname: Lesnikoski
authors.forename: Prakash
authors.initials: P
authors.lastname: Nadkarni
mesh_terms: D000328:Adult; D002983:Clinical Competence; D003142:Communication; D004503:Education, Medical, Graduate; D004521:Educational Measurement; D005260:Female; D013502:General Surgery / Q000193:education*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care; D010817:Physician-Patient Relations; D010865:Pilot Projects