Makoul Gregory, Krupat Edward, Chang Chih-Hung
Center for Communication and Medicine, Northwestern University Feinberg School of Medicine, Division of General Internal Medicine, Chicago, IL 60611, USA.
Patient Educ Couns. 2007 Aug;67(3):333-42. doi: 10.1016/j.pec.2007.05.005. Epub 2007 Jun 18.
Interpersonal and communication skills have been identified as a core competency that must be demonstrated by physicians. We developed and tested a tool that can be used by patients to assess the interpersonal and communication skills of physicians-in-training and physicians-in-practice.
We began by engaging in a systematic scale development process to obtain a psychometrically sound Communication Assessment Tool (CAT). This process yielded a 15-item instrument that is written at the fourth grade reading level and employs a five-point response scale, with 5=excellent. Fourteen items focus on the physician and one targets the staff. Pilot testing established that the CAT differentiates between physicians who rated high or low on a separate satisfaction scale. We conducted a field test with physicians and patients from a variety of specialties and regions within the US to assess the feasibility of using the CAT in everyday practice.
Thirty-eight physicians and 950 patients (25 patients per physician) participated in the field test. The average patient-reported mean score per physician was 4.68 across all CAT items (S.D.=0.54, range 3.97-4.95). The average proportion of excellent scores was 76.3% (S.D.=11.1, range 45.7-95.1%). Overall scale reliability was high (Cronbach's alpha=0.96); alpha coefficients were uniformly high when reliability was examined per doctor.
The CAT is a reliable and valid instrument for measuring patient perceptions of physician performance in the area of interpersonal and communication skills. The field test demonstrated that the CAT can be successfully completed by both physicians and patients across clinical specialties. Reporting the proportion of "excellent" ratings given by patients is more useful than summarizing scores via means, which are highly skewed.
Specialty boards, residency programs, medical schools, and practice plans may find the CAT valuable for both collecting information and providing feedback about interpersonal and communication skills.
人际沟通技巧已被确定为医生必须具备的核心能力。我们开发并测试了一种工具，患者可使用该工具评估实习医生和执业医生的人际沟通技巧。
我们首先开展了一个系统的量表开发过程，以获得一个心理测量学上合理的沟通评估工具（CAT）。这一过程产生了一个包含15个条目的工具，其编写水平为四年级阅读水平，并采用五分制反应量表，5分表示优秀。14个条目关注医生，1个条目针对工作人员。预测试表明，CAT能够区分在单独满意度量表上得分高或低的医生。我们对来自美国不同专业和地区的医生和患者进行了实地测试，以评估在日常实践中使用CAT的可行性。
38名医生和950名患者（每位医生25名患者）参与了实地测试。在所有CAT条目上，每位医生的患者报告平均得分是4.68（标准差=0.54，范围3.97 - 4.95）。优秀分数的平均比例为76.3%（标准差=11.1，范围45.7 - 95.1%）。总体量表信度较高（克朗巴赫α系数=0.96）；按医生检查信度时，α系数始终较高。
CAT是一种可靠且有效的工具，可用于测量患者对医生人际沟通技巧方面表现的看法。实地测试表明，临床各专业的医生和患者都能成功完成CAT。报告患者给出的“优秀”评级比例比通过均值汇总分数更有用，因为均值存在高度偏态。
专业委员会、住院医师培训项目、医学院校和执业计划可能会发现，CAT对于收集有关人际沟通技巧的信息和提供反馈很有价值。
