Canadian physicians who score poorly on the patient-physician communication portion of the national licensing examination receive more complaints to regulatory authorities on issues such as communication or quality-of-care problems, according to an article in the September 5 issue of JAMA, a theme issue on medical education.

Previous research has indicated that poor skills in patient communication are associated with lower levels of patient satisfaction, higher rates of complaints, an increased risk of malpractice claims and poorer health outcomes, according to background information in the article. Medical schools have responded by incorporating training in patient communication and clinical skills in the curriculum.

Robyn Tamblyn, Ph.D., of McGill University, Montreal, and colleagues investigated the ability of clinical skills examinations (CSE) to predict future complaints in medical practice. The study included all 3,424 physicians taking the Medical Council of Canada CSE between 1993 and 1996 who were licensed to practice in Ontario and/or Quebec. Participants were followed up until 2005, including the first two to 12 years of practice. The researchers analyzed data regarding patient complaints to medical regulatory authorities against physicians in the study.

The researchers found that 1,116 complaints were filed for 3,424 physicians, and 696 complaints were retained after investigation. Of the physicians in the study, 21.5 percent had at least one complaint filed, and 17.1 percent had complaint(s) retained in their file after investigation. The majority (81.9 percent) of retained complaints were for attitude/communication and quality-of-care problems. Communication problems in management and inappropriate treatment/follow-up were the most common causes of quality-of-care complaints. A 2-standard deviation decrease in communication score was associated with a 38 percent increase in the complaint rate.

"Our results provide some feedback for medical educators and licensing authorities. Our study supports the predictive validity of providing a standardized assessment of communication skills prior to entry into practice," the authors write. "Current examinations could be modified to test these attributes more efficiently and at earlier points in the training process. Future research should examine whether remediation of communication problems can reduce complaints, and whether other indicators of the quality of practice could be assessed by a clinical skills examination."

JAMA. 2007;298(9):993-1001

Editorial: The Value of Assessing and Addressing Communication Skills

In an accompanying editorial, Gregory Makoul, Ph.D., and Raymond H. Curry, M.D., of the Northwestern University Feinberg School of Medicine, Chicago, write on what can be done regarding communication skills.

"In terms of communication, initiatives could include more systematically assessing interpersonal skills during the admissions process, better connecting clerkship and residency experiences to earlier training in communication skills, and ensuring that clinical skills assessments include a communication component. The momentum is building. More medical schools are adopting a competency-based approach that features interpersonal and communication skills, paralleling the framework that is in place for residency programs and for maintenance of certification."

"At the same time, clinical skills laboratories and simulated-patient expertise are now expanding within U.S. medical schools and rapidly spreading to graduate and continuing medical education. The finding that clinical skills examination scores predict future patient complaints is an important step toward establishing the value of efforts to improve both medical education and patient care."

JAMA. 2007;298(9):1057-1059

Journal of the American Medical Association