Using the Communication Assessment Tool (CAT) to Assess Communication Skills of Family Medicine Residents by Myerholtz, Simons, Felix, Nguyen, Brennan, Rivera-Tovar, Martin, Hepworth and Makoul
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This study assessed the communication skills of 127 family medicine residents across 6 residency programs using the Communication Assessment Tool (CAT), a 14-item patient satisfaction survey. Overall residents received a mean rating of 69.7% excellent from 1880 surveys. Residents scored highest on paying attention, respect, and care/concern. Scores differed by year of training but not gender or native language. The CAT provides an empirical measure of communication competency and can differentiate resident skills and track changes over time. Larger samples and continued benchmarking are needed.
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3/2020 ST 1
September/October 2020 | Volume 38 Number 5 267
Nursing Economic$
Patients spend more time with nurses than any other healthcare
professional. The primary
conduit of information between
the patient and healthcare team
are nurses; therefore, nurses
need to be good
communicators. Careful listening
is at the core of good
communication and is a key
element of patient safety and
experience (Balik & Dopkiss,
2010). A key component of
nurse-patient communication is
the patient’s perception of their
experience with the nurse
listening. Despite the known
importance and impact on
patient experience, quality
outcomes, and reimbursement,
there is a gap in research on
effective nurse communication
from the patient’s perspective.
Healthcare’s shift from
volume to value requires
hospitals to focus on
performance and quality
outcomes, such as patient
experience, as measured by the
Hospital Consumer Assessment
of Healthcare Providers and
Systems (HCAHPS) survey. The
nursing communication domain
within the survey has the
greatest impact on the patient’s
overall experience score (Studer
Group, 2012). The first series of
HCAHPS survey questions focus
on patient care received from
nurses (Centers Medicare &
Medicaid Services [CMS], 2020).
It asks about being treated with
courtesy and respect, nurse
listening, and the nurse’s ability
to explain things in a way the
patient can understand.
Patient experience, a key
hospital performance metric, is a
component of value-based
purchasing (VBP), which holds
providers accountable by linking
Medicare reimbursement to
outcomes. For FY17, the VBP
program affected 2% of the base
operating payments to hospitals.
This resulted in $1.7 billion in
Medicare payments being
withheld from hospitals because
of poor performance on the
HCAHPS survey measuring
patient experience (Becker’s
Hospital Review, 2017).
Research by Press Ganey®
revealed hospitals focusing on
improving the nurse
communication metric could
potentially influence 15% of
Nurses’ Active Empathetic Listening
Behaviors from the Voice of the
Patient
Karen K. Myers
Rebecca Krepper
Ainslie Nibert
Robin Toms
Effective nurse communication,
including listening skills, is
essential to a positive nurse-
patient relationship. This two-
group comparative study
identified how adult hospitalized
patients perceived effect ...
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2. A key barrier is that screening alone does not improve outcomes; a clear clinical pathway and institutional support are needed. The pathway was developed through stakeholder consultation and specifies screening, assessment, referral, and treatment steps.
3. Barriers to implementing the pathway include lack of resources, responsibility issues, staff and patient reluctance. The proposed study will test intensive versus basic strategies to promote pathway uptake, including online training, automated screening/referral systems, and patient/staff educational resources. The goal is to improve psychosocial outcomes for cancer patients.
Respond to the post bellow, using one or more of the followi
Respond
to the post bellow, using one or more of the following approaches:
Ask a probing question, substantiated with additional background information, and evidence.
Share an insight from having read your colleagues’ postings, synthesizing the information to provide new perspectives.
Offer and support an alternative perspective using readings from the classroom or from your own review of the literature in the Walden Library.
Validate an idea with your own experience and additional sources.
Make a suggestion based on additional evidence drawn from the readings or after synthesizing multiple postings.
Data Collection
Data collection methods vary greatly depending on the research question and the type of participants, regardless of chosen methodology, data collection must be rigorously executed to produce high-quality data. Similarly, instruments to collect data must provide accurate, concise, and provide quantifiable data from which clinical meaning can be extrapolated and subsequently applied to effect improvements in practice. In this case, research aims to assess patient satisfaction, from the patient’s perspective. Polit & Beck (2017), report that structured self-report instruments are widely used by nurse researchers, and are typically formatted as either questionnaires or interviews. Surveys provide several advantages. In comparison to interviews, they are cost-effective, maintain the anonymity of respondents, mitigate interviewer bias, and can be easily administered using computer technology. Disadvantages to surveys include low response rates; typically around 50%, exclusion of certain populations such as the elderly and children, questions may lack depth, or be ambiguous or confusing causing respondents to skip them altogether (Polit & Beck, 2017)
Survey Instrument
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- 1. Using the Communication Assessment Tool (CAT) to Assess Communication Skills ofFamily Medicine Residents Linda Myerholtz, Ph.D., Lynn Simons , Psy.D. , Sumi Felix, M.D., Tuan Nguyen, M.D. , Julie Brennan, Ph.D., Ana Rivera-Tovar, Ph.D., Pat Martin, PCC, Jeri Hepworth, Ph.D., Gregory Makoul, Ph.D.
- 2. CAT 14-item patient satisfaction survey Physician interpersonal and communication skills Development based on sound psychometric methods 5-point rating scale: 1 = poor 2 = fair 3 = good 4 = very good 5 = excellent Paper and pencil, phone, internet administration Makoul G, Krupat E, Chang C. Measuring patient views of physician communication skills: Development and testing of the Communication Assessment Tool. Patient Educ Couns 2007; 67:333-342.
- 3. Individualized Resident Sample Report
- 4. Objectives Gather benchmarking data for the use of the CAT in Family Medicine residency programs Examine differences based on: Year in training Native language of the resident (native English speaking vs. non-native English speaking) Gender
- 5. Sample & Methods Six Family Medicine residency programs Midwest & East coast Urban, suburban, rural communities 13-38 residents per program 127 residents Data Collection: Nov 2008- Dec 2008 Paper and pencil version of the CAT 1,880 complete/useable surveys
- 6. Scoring: Mean ratings Overall By item Percentage of “Excellent” ratings Overall By Item
- 7. Demographic Characteristics of Residents
- 8. Results Overall mean percent “excellent” = 69.7% (SD = 40.4) Items rated most frequently as “excellent” Paid attention to me (73.6%) Treated me with respect (72.8%) Showed care and concern (72.6%) Items rated least frequently as “excellent” Encouraged me to ask questions (63.2%) Involved me in decisions (64.9%) Consistent with Makoul et al.’s findings for practicing physicians
- 9. Training Year Overall p = .015 PGY 1 vs. PGY 2 p =.018 ; PGY 1 vs. PGY 3 = p =.004 ; PGY 2 vs. PGY 3 = p = .55
- 10. Native Language p = .06
- 11. Gender p = .81
- 12. Limitations Sample = Convenience sample of volunteering programs Variability in the number of surveys collected per resident
- 13. Advantages Measures patient’s perspective User friendly administration & scoring Provides empirical measure of core ACGME competency Differentiates between residents Easy to track changes over time Benchmark data now available
- 14. Lessons Learned & Future Needs Increase sample sizes Evaluate changes over time Consider efficacy of a minimum passing score 58% has been recommended2 Continue to expand benchmarking data 2Wayne D, Cohen E, Makoul G, McGaghie W. The impact of judge selection on standard setting for a patient survey of physician communication skills. Acad Med 2008; 83: S17-20.