Purpose Standardized patients (SPs) are routinely used during medical education for the assessment of clinical skills, particularly history-taking and physical examination skills. However, no studies have assessed whether SP ratings of interpersonal skills and satisfaction are predictive of actual patient satisfaction.
Methods During the 1999-2002 academic years, all internal medicine residents at the University of Kentucky underwent a single SP Clinical Evaluation Exercise (CEX), during which residents were expected to do a complete history and physical on an SP portraying a common medical condition. After each resident encounter, the SP completed a series of checklists, including rating resident nonverbal behaviors and their overall satisfaction with the “visit.” Nonverbal behavior was rated on a 10-item, 7-point Likert-type instrument (eg, The residents tone of voice was 1 = unexpressive, monotone to 7 = very expressive, emotional). SP satisfaction was assessed on a 5-item, 7-point Likert-type scale. Resident nonverbal behavior and SP satisfaction were represented by the mean score across the 10 items and 5 items, respectively. Over the same time period, patients in the internal medicine resident continuity clinics completed a 7-item patient satisfaction questionnaire on the residents. The patient satisfaction questionnaire consisted of seven commonly used patient satisfaction statements rated on a 10-point Likert-type scale. For the purposes of analysis, patient satisfaction was represented as the mean score across all seven items on this questionnaire. The data were analyzed using simple correlation and multiple regression approaches to assess the association between SP ratings and actual patient satisfaction.
Results A total of 86 residents had ratings from both SPs and clinic patients. Actual clinic patient satisfaction was correlated to both SP ratings of satisfaction (r = .31, p = .003) and resident nonverbal skills (r = .29, p = .006). In the multiple regression analysis, controlling for resident gender and experience, actual patient satisfaction was independently predicted by SP ratings of resident nonverbal behavior (p = .03) but not by the completeness of the resident's history-taking and physical examination.
Conclusions During a single-station SP CEX, resident nonverbal behaviors and SP ratings of satisfaction are both associated with actual patient satisfaction. Further, nonverbal communication seems more important than thoroughness of the visit in predicting patient satisfaction. Educators should consider using SPs to provide trainees feedback about their interpersonal skills, particularly nonverbal behaviors.
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