Wednesday, July 1, 2015

Communication as a Medical Skill (ComMS): A randomized control trial to evaluate the effect of a novel communication curriculum to develop rapport and therapeutic relationships in acute care environments.

Karl Hartwick, MD, FRCPC, MEd
University of Ottawa

Objective: To evaluate the effect of the “Communication as a Medical Skill” curriculum (ComMS) on physician communication skills.

Methods: We tested skill building and skill retention interventions in randomized controlled trials among 18 graduate year-one internal medicine and anesthesia residents.
The primary outcome was score on the ComMS Skills Assessment Performance Rating Tool which assesses ability to establish rapport and a therapeutic relationship during videotaped acute care scenarios with standardized patients. During the skill building phase, residents were randomized to ComMS curriculum (N=10) vs. active control curriculum (N=8), both were 4 hours long. After the skill building outcomes were assessed, residents in the ComMS group were randomized to 2 hours of executive coaching (N=5) vs. no coaching (N=5). Retention of skills was assessed in all residents 3 months later.

Results: Scores of residents receiving the ComMS curriculum improved significantly (pre-test mean [SD] = 69.5 [2.9] to post-test = 74.8 [3.4] compared with the control group (pre-test mean [SD] = 64.4 [3.8] to post-test = 64.8 [4.9]; paired t-test: t[17] = 2.90, p=0.010). We did not observe any significant differences between groups in retention of communication skills from post-intervention to three months follow-up (t[15] = 0.25, p = 0.8076). Retention of communication skill at three month follow-up was not affected by executive coaching (t[7] = 0.44, p = 0.67). The ComMS intervention group showed an improved ability to construct empathic responses compared with the control group (t[16] = 3.24, p=0.005) following the skill building component of the study.

Conclusion: This study demonstrates the ability to train and measure the complex communication skills of establishing a therapeutic relationship and empathic expression.

Practice Implications: Educational interventions such as ComMS may improve the ability of physicians to communicate effectively in acute care medical practice where time pressures and a lack a pre-existing relationships are seen as barriers to effective physician-patient communication.