Impact of supervision and self-assessment on doctor-patient communication in rural Mexico
Kim, Y-Mi.; Figueroa, M.Elena.; Martin, A.; Silva, R.; Acosta, S.F.; Hurtado, M.; Richardson, P.; Kols, A.
International Journal for Quality in Health Care Journal of the International Society for Quality in Health Care 14(5): 359-367
2002
ISSN/ISBN: 1353-4505 PMID: 12389802 DOI: 10.1093/intqhc/14.5.359Document Number: 267236
Objective: To determine whether supervision and self-assessment activities can improve doctor-patient communication. Setting and participants: Six supervisors, 60 doctors in their last year of training, and 232 primary health care patients at rural health clinics in Michoacan, Mexico. Design: The main evaluation compared post-intervention measures in control and intervention groups. A small panel study also examined changes from baseline to post-intervention rounds in both groups. Intervention: Over a 4-month period in 1998, specially trained supervisors added 1 h of supervision on interpersonal communication and counselling (IPC/C) to regular site visits. Doctors, who had received prior IPC/C training, periodically audiotaped and assessed their own consultations. Main outcome measures: These comprised frequency of doctors' facilitative communication, doctors' biomedical information-giving, and patients' active communication. Results: The performance of all doctors improved markedly over the study period, but gains in facilitative communication and information-giving were significantly greater in the intervention than the control group. No single component of the intervention was responsible for the improvement; it resulted from the combination of activities. The doctors appreciated the more supportive relationship with supervisors that resulted from the intervention and found listening to themselves on audiotape a powerful, although initially stressful, experience. Conclusion: Supportive supervision and self-assessment activities can reinforce IPC/C training, prompt reflection and learning, and help novice doctors improve their interpersonal communication skills.