A method to quantify and compare clinicians' assessments of patient understanding during counseling of standardized patients. Patient Educ Couns 2009 Oct;77(1):128-35
Date
04/22/2009Pubmed ID
19380210Pubmed Central ID
PMC2737092DOI
10.1016/j.pec.2009.03.013Scopus ID
2-s2.0-69249219024 (requires institutional sign-in at Scopus site) 30 CitationsAbstract
OBJECTIVE: To introduce a method for quantifying clinicians' use of assessment of understanding (AU) questions, and to examine medicine residents' AU usage during counseling of standardized patients about prostate or breast cancer screening.
METHODS: Explicit-criteria abstraction was done on 86 transcripts, using a data dictionary for 4 AU types. We also developed a procedure for estimating the "load" of informational content for which the clinician has not yet assessed understanding.
RESULTS: Duplicate abstraction revealed reliability kappa=0.96. Definite criteria for at least one AU were found in 68/86 transcripts (79%). Of these, 2 transcripts contained a request for a teach-back ("what is your understanding of this?"), 2 contained an open-ended AU, 46 (54%) contained only a close-ended AU, and 18 (21%) only contained an "OK?" question. The load calculation identified long stretches of conversation without an AU.
CONCLUSION: Many residents' transcripts lacked AUs, and included AUs were often ineffectively phrased or inefficiently timed. Many patients may not understand clinicians, and many clinicians may be unaware of patients' confusion.
PRACTICE IMPLICATIONS: Effective AU usage is important enough to be encouraged by training programs and targeted by population-scale quality improvement programs. This quantitative method should be useful in population-scale measurement of AU usage.
Author List
Farrell MH, Kuruvilla P, Eskra KL, Christopher SA, Brienza RSMESH terms used to index this publication - Major topics in bold
AdultBreast Neoplasms
Clinical Competence
Communication
Curriculum
Education, Medical, Graduate
Educational Status
Female
Health Knowledge, Attitudes, Practice
Humans
Internal Medicine
Internship and Residency
Male
Mass Screening
Patient Education as Topic
Physician-Patient Relations
Prostatic Neoplasms
Referral and Consultation
Reproducibility of Results
Surveys and Questionnaires
United States
