International medical graduates (IMGs) currently fill one-quarter of the positions in graduate medical education. The Academy of American Family Physicians (AAFP) estimates that approximately 48% of all first-year family medicine residents graduated from a US medical school. There are limited national data on the differences in self-perception and confidence between IMGs and USMGs in using their communication skills during the physician-patient encounter.
Purpose The purpose of our study was (1) to assess differences in perception and confidence level of communication skills between USMGs and IMGs family medicine residents and (2) examine differences in perception and confidence level between first-, second-, and third-year postgraduates.
Method Program directors at all accredited family medicine residencies were contacted via e-mail and asked to direct their residents to a voluntary anonymous cross-sectional Web-based survey. The questionnaire measured six areas: participant demographics, physician confidence level of using communication skills, the importance of using communication strategies for a positive patient outcome, the use of specific communication strategies, the importance of closing the encounter for a positive patient outcome, and the use of specific strategies for closing the patient encounter.
Main Findings A total of 108 surveys were received from the on-line survey questionnaire, of which 27% were IMG and 72% of the respondents were USMG; 19.8% were PGY1, 42.5% PGY2, and 37.7% were PGY3; and 91.0% of respondents indicated that they were confident in their use of communication skills; however, they indicated a need to improve in 16 of 18 communication strategies. Respondents believed that communication strategies are important for positive patient outcomes and in closing the patient encounter; 95.9% of respondents indicated the importance of closing the patient encounter. Yet 92.3% replied that closing strategies were rarely or never implemented. Preliminary analysis also suggests differences in the confidence and use of communication skills between IMGs and USMGs. PGY1 felt less confident in all areas of their perception of patient communication in comparison with the other years.
Conclusion Family medicine residents recognize the importance and the need of communication skills during their patient interaction. However, there is a gap between the perceived importance and practice of these skills. There may also be specific concerns relevant to IMGs in particular. Great effort is needed in increasing the use of communication strategies among residents and their patients to improve the likelihood of a positive patient encounter.