title: The effect of patient feedback on physicians' consultation skills: a systematic review.
abstract: OBJECTIVE
  The effect of patient feedback interventions as a method of improving physicians' consultation (i.e., communication, interpersonal) skills is equivocal; research is scarce, and methods and rigor vary. The authors conducted this systematic review to analyze the educational effect of feedback from real patients on physicians' consultation skills at the four Kirkpatrick levels.
  
  
  METHODS
  The authors searched five databases (PubMed, EMBASE, Cochrane, PsycInfo, ERIC; April 2010). They included empirical studies of all designs (randomized controlled, quasi-experimental, cross-sectional, and qualitative) if the studies concerned physicians in general health care who received formal feedback regarding their consultation skills from real patients. The authors have briefly described aspects of the included studies, analyzed their quality, and examined their results by Kirkpatrick educational effect level.
  
  
  RESULTS
  The authors identified 15 studies (10 studies in primary care; 5 in other specialties) in which physicians received feedback in various ways (e.g., aggregated patient reports or educator-mediated coaching sessions), conducted in the United States, the Netherlands, the United Kingdom, Australia, and Canada. All studies that assessed level 1 (valuation), level 2 (learning), and level 3 (intended behavior) demonstrated positive results; however, only four of the seven studies that assessed level 4 (change in actual performance or results) found a beneficial effect.
  
  
  CONCLUSIONS
  Some evidence for the effectiveness of using feedback from real patients to improve knowledge and behavior exists; however, before implementing patient feedback into training programs, educators and policy makers should realize that the evidence for effecting actual improvement in physicians' consulting skills is rather limited.
authors.affiliation: EMGO (Extramuraal Geneeskundig Onderzoek) Institute of Health and Care Research, Department of General Practice, VU (Vrije Universiteit) University Medical Center, Amsterdam, The Netherlands. marcel.reinders@vumc.nl
authors.forename: Marcel E
authors.initials: ME
authors.lastname: Reinders
authors.forename: Bridget L
authors.initials: BL
authors.lastname: Ryan
authors.forename: Annette H
authors.initials: AH
authors.lastname: Blankenstein
authors.forename: Henriëtte E
authors.initials: HE
authors.lastname: van der Horst
authors.forename: Moira A
authors.initials: MA
authors.lastname: Stewart
authors.forename: Harm W J
authors.initials: HW
authors.lastname: van Marwijk
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D005246:Feedback; D005260:Female; D006801:Humans; D008297:Male; D008511:Medicine / Q000379:methods / Q000639:trends; D009426:Netherlands; D010358:Patient Participation; D010817:Physician-Patient Relations; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000639:trends; D011320:Primary Health Care / Q000379:methods / Q000639:trends; D016032:Randomized Controlled Trials as Topic; D012017:Referral and Consultation; D017749:Total Quality Management