Special Issue: Doctor-patient Communication
The phase of undergraduate medical education is the starting point for fostering communication competence of students in Rural-oriented Free Tuition Medical Education Program (RTME), which lays the foundation both for communication competence training in the postgraduate education phase and performing effective communications with patients and their relatives, colleagues, and other health personnel in the career life of general practitioners (GPs). It is of great practical significance to explore how to improve quality of doctor-patient communication education in the stage of undergraduate medical education and develop doctor-patient communication competence of the RTME students.
To explore the role of the ladderlike communication skill course on fostering doctor-patient communication competence of students in rural-oriented free tuition medical education program.
A total of 259 RTME students of Grade 2019 were selected from Guangxi Medical University in September 2019 to establish Cohort 1, and 262 undergraduate medical students of Grade 2019 were selected to establish Cohort 2. From September 2019 to January 2022, the students in Cohort 1 were trained in a ladderlike communication skill course lasting for five consecutive semesters; from September 2021 to January 2022, the students in both cohorts were trained in a doctor-patient communication course. The final exam scores and process assessment scores of the two cohorts on the doctor-patient communication course were compared and the evaluation of teaching effectiveness and satisfaction of ladderlike communication skill course were investigated in the students in Cohort 1.
The RTME students achieved significantly greater total scores for the final exam of the doctor-patient communication course, in which the RTME students performed better on the sections of case analysis and small essay, but worse on the single-choice question section compared to the undergraduate medical students (P<0.05). Similarly, the RTME students obtained higher scores on the process assessment of the doctor-patient communication course than undergraduate medical students, resulting from higher scores on the dimensions of information collection, information giving, negotiation and resolution, and nonverbal communication skills (P<0.05), and there was no statistically significant difference in the scores on the dimension of establishing first impression (P>0.05). Over 80% of RTME students felt satisfied or absolutely satisfied with the content, pedagogical measures, faculty, schedule and effects of the ladderlike communication skill course, and more than 60% believed it helped or absolutely helped promote learning interest, increase confidence to encounter difficult patients, and raise multiple competence, including empathy, doctor-patient communication, language expression, problem resolution, and team work.
The ladderlike communication skill course significantly elevates the effects of doctor-patient communication education in the phase of undergraduate medical education for the RTME students, facilitates the development of doctor-patient communication competence and other comprehensive competence. The ladderlike course mode is an effective measure fostering doctor-patient communication competence of medical students in medical education, and makes a useful reference for communication competence training for postgraduate education and continuing education of general practice.
General practitioners (GPs) play an important role in diabetes care in primary care as the "gatekeepers" of population health. The management of diabetes can slow its progression, reduce complications and improve patient outcomes, which requires effective communication and collaboration between patients and their doctors. GPs with good communication skills can help to build long-term care relationships with diabetes patients and help them develop effective self-management skills. This paper summarizes the design and development of diabetes communication skills training for GPs guided by research team with multiple theoretical frameworks, including evidence-based findings from systematic review, experiences and ideas of diabetes patients communicating with GPs based on qualitative studies, prioritization of training content for patient-doctor communication in GPs captured by mixed-methods research, in order to provide new ideas for high-quality diabetes management in primary care and inform the design of training programmes for GPs based on evidence and medical education frameworks.
The concept of "patients-centered" has presented higher requirements doctor-patient communication and reconstructing doctor-patient relationship in public primary health care institutions.
To analyze the impact of "patients-centered" doctor-patient communication on the quality of primary care services, and provide scientific evidence to promote reforms in public primary health care institutions.
All public community health centers providing primary care services in the main urban area of a city in Inner Mongolia Autonomous Region were selected as the study sites to conduct a field survey in 2021 using the standardized patient method, which included 118 items of doctor-patient communication data involving 26 medical institutions, 59 doctors, and 12 standardized patients. Common cold, asthma, and unstable angina were selected as the types of diseases to be portrayed by the standardized patients in this study. A combination of multiple regression model and Probit model was used to evaluate the impact of "patients-centered" doctor-patient communication on the quality of primary care services.
Results obtained from the 118 items of doctor-patient communication data revealed that the median adherence rate for recommended consultation items was 17.6% (14.6%), and the median adherence rate for recommended examination items was 25.0% (40.0%), among them, 75 cases (63.6%) were correctly diagnosed, and 59 cases (50.0%) were correctly treated. The median total cost was 84.84 yuan (130.44 yuan), and the median drug cost was 37.62 yuan (47.38 yuan), among them, 66 (55.9%) involved unnecessary drugs, and 71 (60.2%) included unnecessary examinations. The median visit duration was 13.625 (10.850) min. The average score for "patients-centered" doctor-patient communication was (26.712±10.658), with the first dimension scoring (12.915±5.355) points, the second dimension scoring (7.492±2.867) points, and the third dimension scoring (6.305±3.465) points. The results of multiple linear regression model and Probit model indicated that for every one-point increase in the total score of patient-centered doctor-patient communication, the adherence rates for both recommended consultation items and recommended examinations items increased by 0.001 percentage points, the correct diagnosis rate increased by an average of 4.6 percentage points, the correct treatment rate increased by 4.2 percentage points, the total cost increased by 1.993 yuan, the drug cost increased by 0.517 yuan, the proportion of unnecessary drugs decreased by 3.4 percentage points, the proportion of unnecessary examinations increased by 0.2 percentage points, and the visit duration decreased by 0.291 minutes.
"Patients-centered" doctor-patient communication enhances the effectiveness and safety of medical services, while it also increases medical costs. It is necessary to promote "patients-centered" doctor-patient communication from the aspects of resource endowment, salary incentives, doctor-patient relationships, and collaborative services, thereby improving the quality of primary care services.
Graduate supervisors in general practice are responsible for the important task of training future general practice professionals, so their abilities to communicate with patients are essential for the development of general practice.
To examine the abilities to communicate with patients in supervisors of master's students in general practice during outpatient encounters.
Seventy-five supervisors of master's students in general practice from Capital Medical University were selected by use of cluster sampling to receive a survey using a self-developed demographic questionnaire conducted from April to June 2022. Then their doctor-patient communication skills during outpatient encounters were assessed by relevant professionals who participated in the whole encounter process as accompaniers using the SEGUE Framework. The total score and dimension scores of SEGUE Framework of these supervisors were compared with those of outpatient specialists in tertiary hospitals and general practitioners (GPs) in community health centers (CHCs) in our previous studies, and were compared across these supervisors by sex, employment method and level of medical institutions. Then the total score of SEGUE Framework was compared between the supervisors and US GPs.
The total score of SEGUE Framework attained by the supervisors ranged from 12 to 24 points, and the average score was (17.8±2.6) . The average scores of five dimensions (set the stage, elicit information, give information, understand the patient's perspective, and end the encounter) obtained by them were (3.9±0.9) , (6.5±1.7) , (3.1±1.1) , (2.6±0.9) and (1.7±0.5) , respectively. These supervisors scored higher on dimensions of set the stage and end the encounter than GPs in CHCs and outpatient specialists in tertiary hospitals (P<0.05) . Compared with their counterparts working in primary hospitals, supervisors working in secondary hospitals scored lower on the SEGUE Framework and set the stage dimension (P<0.05) , and those working in tertiary hospitals scored lower on the SEGUE Framework and set the stage and elicit information dimensions (P<0.05) . These supervisor scored lower on the SEGUE Framework than the US GPs (P<0.05) .
There is still considerable room for improvement of the skills for communicating with patients in outpatient encounters in these supervisors. Their level of communication skills was still lower than that of US GPs. In view of this, the teaching management department responsible for general practice department (school) should pay attention to the training of the abilities of master supervisors to communicate with patients, thereby improving the level of medical humanities in practice in master's students in general practice by supervisors' words and deeds.
Doctor-patient communication barrier is one of the major causes leading to medical disputes. Still, there are limited studies and rare instruments with good reliability and validity regarding doctors' ability to communicate with patients in China.
To construct the Five Habits Coding Scale (5HCS) and verify its reliability and validity.
The first draft of the Five Habits Coding Scale (5HCS) was formulated based on the Chinese version of the Four Habits Coding Scheme (4HCS) developed using Brislin's translation model in March 2014. Then from April to June 2014, the items of the first draft of 5HCS were revised in accordance with the expert consensuses obtained from two rounds of Delphi consultations, and after that, the final version of the 5HCS was developed, and utilized to evaluate 127 residents' abilities to communicate with patients in March 2018 for testing its internal consistency, inter-rater reliability, content validity and criterion-related validity.
The final version of 5HCS consists of 21 items fell under 5 dimensions, namely "Show respect and kindness, harmonize doctor-patient relationship" "Provide information, guide patients' views" "Demonstrate empathy, build up trust" "Risk disclosure, informed consent", and "Provide diagnostic information, shared-decision making". The Cronbach's α of the scale was 0.716. The dimension-total correlation coefficients (Pearson correlation coefficients) ranged from 0.524 to 0.692, and the content validity index of each item (I-CVI) ≥0.81. The inter-rater reliability was calculated by intraclass correlation (ICC) (Pearson coefficient=0.912, ICC=0.912, P<0.01) . And the criterion-related validity was testified by comparing to the Chinese version of SEGUE (r=0.377, P<0.01) .
The 5HCS has been proved to be highly reliable and valid, so it could be applied and promoted as a tool to evaluate the doctor-patient communication ability of residents in China.
Special Issue: Doctor-patient Communication
