faculty ratings of resident humanism predict patient satisfaction ratings in ambulatory medical...

Faculty Ratings of Resident Humanism Predict Patient Satisfaction Ratings in Ambulatory Medical Clinics

PETER J. McLEOD, MD, ROBYN TAMBLYN, PhD, SAM BENAROYA, MD, LINDA SNELL, MD

Objective: To determine whether patient satisfaction ratings can be predicted by faculty ratings or self-ratings of resident humanism. Design: A prospective three-month collection of patient satisfaction ratings in two ambulatory care clinics and simultaneous acquisition of faculty ratings and self-ratings of resident humanism using ABIM questionnaires. Setting: Two teaching hospital ambulatory care internal medicine clinics. Participants: Forty-seven internal medicine residents and 17 faculty internists were sent questionnaires for evaluation of humanism of individual residents. One thousand one hundred ninety-four consecutive outpatients cared for by the residents were eligible for patient satisfaction questionnaires. Measurements a n d m a i n results: Thirty-three residents and 13 faculty completed evaluations (ff resident humanism while 792 patients completed satisfaction questionnaires, which were used for analysis. The faculty ratings of resident humanism correlated strongly with patient satisfaction ratings, while the resident serf-ratings did not. Conclusions: Faculty ratings of resident humanism were highly predictive (ff patient satisfaction with the care rendered by internal medicine residents in two ambulatory care clinics. This suggests that ambulatory care settings are useful for evaluation of noncognitive behavioral features of resident performance. Ke), words: patient satisfaction; residents; performance assessment; humanism; ambulatory care clinics. J GEN INTERN MED 1994;9:321 326.

THE SCIENTIFIC EXPLOSION of the last few decades has con-

t r ibuted to an overemphas is on the cogni t ive and technical aspects of med ic ine at the expense of the inter- p e r s o n a l skills and h u m a n e qua l i t i e s of p r a c t i c i n g physicians. 1-~ This can have significant pract ical con-

sequences because there is a s t rong re la t ionship between the characterist ics of a p h y s i c i a n - p a t i e n t inter- action and numerous health benefits, including improved patient compliance, 4 r educed n u m b e r s of medica t ion errors, 5" (' improved b lood pressure control , 7 and improved cont ro l of diabetes. 8" 9 Consequent ly , many med-

ical educators n o w acknowledge the n e e d for a r e n e w e d emphasis on the educa t ion of s tudents in the humanis t ic aspects of medicine. 1 0 - - 1 2

One study suggests that res idents recognize defi- ciencies in how human i sm is taught at the postgraduate

level, ~3 and one major body, the Amer ican Board of

Received from McGill University, Departments of Medicine and Epi- demiology and Biostatistics, Montreal General and Royal Victoria Hos- pitals, Montreal, Quebec, Canada.

Supported by the Fonds de la recherche en sant~ du Quebec and the Royal Victoria Hospital Department of Medicine research and education fund.

Address correspondence and reprint requests to Dr. McLeod: Department of Medicine, Montreal GenerM Hospital, 1650 Cedar Av- enue, Montreal, Quebec, H3G 1A4, Canada.

Internal Medicine, has encouraged program directors to foster and evaluate humanis t i c behaviors in residents and specialty fellows. 1~ Unfortunately, there are signif-

icant difficulties wi th evaluat ion of humanis t ic behav-

iors. Faculty often do a poo r job of evaluat ing residents.

In one study, 203 faculty m e m b e r s observed v ideotaped r e s i d e n t - p a t i e n t interact ions, then evaluated the residents ' clinical skills. Is Those evaluators w ho used an

open-ended evaluat ion form usually failed to c o m m e n t

on humanis t ic skills. A subset w h o used a s t ruc tured

evaluation form displayed little agreement beyond chance

on humanis t ic quali t ies o ther than "respect" and "con- sideration." In a s tudy of pediatr ic res ident evaluations,

faculty showed good in ter ra ter ag reement on i tems conce rn ing medical knowledge bu t had significant difficulty

achieving consensus on ratings of in te rpersonal rela- t ionship skills, t° Similar conce rns were repor ted for a

study of clinical clerk evaluations, w he r e faculty eval-

uators indica ted that they were more in f luenced by

knowledge and clinical skills than by personal charac-

teristics w h e n evaluat ing p e r f o r m a n c e s ) 7

Self-rating of pe r fo rmance is a potent ia l ly useful way to he ighten res ident awareness of issues related to the

impor tance of humanism, bu t little is k n o w n about cor-

relations b e t w e e n serf-evaluations, faculty evaluations, and pat ient evaluations. In medic ine , researchers have tended to concen t r a t e on cogni t ive per formance domains and not h u m a n i s m w h e n they explore the uti l i ty

of self ratings. In these domains, learners may rate them-

selves lower than do their tutors, m Patients, as the rec ip ients of medical care, should

be valid sources of in format ion about res idents ' humanistic qualities, so it is no t surpr is ing that several inves- tigators have exp lo red pat ients ' pe rcep t ions of human- isflL 19-21 However, a variety of methodo log ic p rob lems

have been encoun te red . Webs te r 21 suggests that ratings from as many as 20 to 40 pat ients are requi red to ob ta in a meaningful ind ica t ion of a res ident ' s humanis t ic skills. Mathcws et al. 20 identify a major p r ob l e m with inpat ien t

ratings of res ident humanism. They indicate that such

ratings may reflect a compos i t e v iew of an ent i re ward

team's pe r fo rmance and not that of a single caregiver.

Also, seriously ill pa t ien ts in hospital may feel a need to repor t that their car ing physicians are part icularly skillful

in all aspects of per formance . Perhaps this might partially

explain why Klessig et al. 22 found no corre la t ion be-

twcen inpat ients ' ratings of satisfaction wi th their care and faculty evaluat ions of h u m a n i s m of the res idents on

the ward team.

321

322 McLeod et al., RESIDENT HUMANISM RATINGS AND PATIENT SATISFACTION

The current emphasis on inpatient services for resident education may play a role in hampering the development of a credible system of evaluation of resident humanism. We hypothesized that the ambulatory care setting might be the best site for evaluating humanism since ambulatory patients are less seriously ill than inpatients and therefore may be more objective in their evaluations of residents. In addition, faculty evaluators may be better placed to observe resident-pat ient interactions there since their teaching interactions are or- dinarily with a single resident rather than a team. If patient satisfaction with a resident's care correlates with faculty evaluation of that resident's humanism, then ambulatory care areas may be more appropriate than inpatient wards for evaluation of humanism and faculty ratings obtained in this setting may be more valid. If resident self-evaluations correlate with patient satisfaction, such evaluations might prove useful in individual residents and to program directors interested in foster- ing humanistic behavior.

The purpose of this study was to determine whether patients' ratings of satisfaction with a resident's physi- c ian-pat ient relationships in ambulatory care can be predicted by 1 ) faculty ratings of the resident's humanistic qualities and 2) the resident's self-ratings of his or her own humanistic qualities.

METHODS

Design and Study Population

The association between faculty ratings and self- ratings of resident humanism and patient satisfaction was assessed using a cross-sectional survey design. Three study populations were identified: residents, supervising faculty physicians, and patients. Forty-seven internal medicine residents at two McGill University teaching hospitals were eligible for inclusion in the study. All residents attended a half-day ambulatory clinic at one of the two teaching hospitals and each was regularly supervised by the same two or three faculty physicians over the course of an academic year. The 17 internists who supervised residents in these clinics constituted the eligible pool of supervising physicians from whom resident ratings were requested. The study population of patients consisted of all patients who were seen by the 47 internal medicine residents over a consecutive three- month period in the two teaching hospitals. Eligible residents, faculty, and patients were asked to participate, and those consenting to do so were included in the study.

Measurements

Resident Humanist ic Qualities. The Professional Associate Rating Form of the American Board of Internal Medicine 23 was used to rate the residents' humanistic qualities. Six components of humanism were evaluated:

verbal communication, respect, integrity, compassion, responsibility, and responsiveness to psychosocial issues. Each component was rated on a nine-point, be- haviorally anchored ordinal scale. Reproducibility of rating has been estimated to be 0.7 (intraclass correlation) with 11 ratings. 24 All consenting faculty were given rating forms and asked to complete one for each resident with whom they had worked for a period long enough to afford a reasonable assessment of the individual's humanistic qualities. The residents were given the same form and asked to evaluate their own humanistic qualities in comparison with those of their peers.

Patient Satisfaction. The American Board of In- ternal Medicine Aggregated Questionnaire was used to measure patient satisfaction. 21 This questionnaire con- tains ten items, each rated on a five-point ordinal scale using descriptors: 1 = poor, 2 -~ fair, 3 --- good, 4 = very good, and 5 = excellent. Internal validity coefficients for this questionnaire were in the range of r = 0.42 to r = 0.72; average interitem correlations were r = 0.85, and reproducibility for rating patient satisfaction with a resident has been estimated to be 0.70 with 20 patient ratings. 21

The questionnaire was translated into four lan- guages (Greek, French, Italian, and Portuguese) to max- imize response rates from the principal ethnic groups served by the two hospitals. To minimize nonresponses due to illiteracy, we offered each patient the option of completing the questionnaire with the assistance of an interviewer. A research assistant located in each hospital recruited eligible patients into the study, interviewed patients preferring this option, and abstracted the clinic appointment log to verify the eligible patient population. To minimize the contribution of interviewer effects on satisfaction ratings, the two research assistants spent equivalent amounts of time in the two clinics. The patients completed the patient satisfaction questionnaire immediately after the visit with the resident. The questionnaire was then coded with the resident's assigned research number.

Analysis

To create an overall score of each resident's humanistic qualities (for both self-evaluation and faculty evaluation), we used the mean of all item ratings. When more than one faculty member rated a resident, we calculated the mean rating of each and then calculated the mean of all staff ratings. A visit score for each patient's satisfaction rating was obtained by taking the mean of all items rated. The patient had to rate at least four of the ten questionnaire items to be included in further analysis. A patient satisfaction score for each resident was obtained by taking the mean of all visit ratings completed by the participating patients of the respective resident. To detect response bias, the patient satisfaction scores and humanistic quality scores (faculty ratings) of

JOURNAL OF GENERAL INTERNAL MEDICINE, Volume 9 (June), 1994 323

TABLE 1

Scores for Self-ratings and Faculty Ratings (Mean _+ SD) for All Residents Combined, Plus Differences between Self- and Faculty Ratings for Individual Residents

Humanistic Quality

Average Differences* between Self- and Faculty Ratings for

Combined Self-rating Combined Faculty Rating Individual Residents (n = 33) (n = 29) (n = 29)

Verbal communication Respect Integrity Psychosocial aspects of illness Compassion Responsibility

OVERALL

6.55 _+ 0.75 6.17 _+ 1.28 +0.10 +_ 1.33 6.79 _+ 1.05 6.74 +_ 1.12 -0 .10 +- 1.42 6.81 _+ 0.70 6.80 +_ 1.26 -0 .14 _+ 1.35 6.65 _+ 1.03 6.65 _+ 1.24 -0 .63 + 1.34t 6.39 + 1.09 6.66 _+ 1.49 -0.51 + 1.385 7.06 _+ 0.86 6.79 _+ 1.43 +0.19 -+ 1.34

6.61 _+ 0.69 6.65 +- 1.49 -0 .19 -+ 1.14

*A difference score was created for each resident by subtracting the average faculty rating provided for him or her from his or her self-rating. tp < 0.01. Jp < 0.05.

participating and nonparticipating residents were com- pared using an independent t-test. The reliability of faculty and patient ratings was assessed by intraclass correlation coefficient. We used Spearman's rank-order and Pearson p r o d u c t - m o m e n t correlations to evaluate the association be tween patient ratings, self-ratings, and staff ratings. In secondary analysis, we used correlation and linear regression analysis to identify the specific humanistic qualities most strongly associated with a resident 's patient satisfaction score.

RESULTS

Of the 47 eligible residents, 33 (70 .2%) agreed to be study participants and comple ted the self-rating of humanistic qualities. The participating residents received slightly higher ratings from the faculty members on all dimensions of humanistic qualities than did the nonparticipating residents, but none of these differences was statistically significant. There was no significant difference in average patient satisfaction ratings be tween the participating and nonparticipating residents.

Of the 17 faculty members, 13 re turned comple ted rating forms for the residents they supervised. The number of residents rated by each varied from four to 14. In total, 38 of the 47 residents were rated by the faculty; the minimum number of faculty ratings per resident was two and the maximum was three.

A total of 1,079 of 1,194 consecutive patients who were booked for visits with eligible residents arrived for their appointments, and 964 were asked to participate in the study. For 115 patient visits the patient was not approached because the clinic became too busy and the patient had left the clinic before the research assistant was able to contact him or her. Of the 964 patients who were asked to participate, 898 (93%) agreed. Of these, 792 (82%) rated at least four of the ten questionnaire items and were used in the analysis. On average, 17 patient ratings were collected for each resident (range three to 53). The five residents with fewer than five

patient ratings were excluded from further analysis because the reproducibili ty of their scores was unaccept- able (intraclass correlation of 0.3) for meaningful inter- pretation. For the remaining residents, 24.5% had five to ten ratings each, 36.8% had 11 to 20 ratings, 12.2% had 20 to 30 ratings, and 16.3% had more than 30 ratings.

Table 1 details the average self- and faculty ratings of humanistic qualities for all the residents combined as well as the average differences be tween self-ratings and faculty ratings for individual residents. Mean faculty ratings on the six dimensions varied from 6.17 to 6.80, and the average correlation among items was r = 0.81. The dimension receiving the lowest average faculty rating was verbal communicat ion, and the dimension receiving the highest average rating was integrity. The residents as a group rated themselves higher than did the faculty on all dimcnsions except attention to the psychosocial aspects of illness and compassion. The average interi tem correlation for the self-ratings was 0.49. Although the residents as a group rated themselves higher than did the faculty, this t rend was not evident at the level of individual residents. As seen in column 3 of Table 1, the average difference be tween faculty rating and self-rating for individual residents was 0.19, indicating that individual residents tended to rate themselves slightly lower than did their attending staff physicians. The difference in trends at the individual level in comparison with the group trend is explained by the tendency for the residents with the highest faculty ratings to rate themselves more harshly than did the residents given average or lower ratings by the faculty. For example, the residents in the upper quartile of faculty ratings rated themselves on average 1.23 points lower than did the faculty, while the residents in the third quartile rated themselves 0.80 of a point lower than did the faculty. In contrast, the residents in the second and bot tom quartiles of faculty rating rated themselves 0.067 and 0.087 points higher than did the faculty.

The overall Pearson p r o d u c t - m o m e n t correlation

324 McLeod et al., RESIDENT HUMANISM RATINGS AND PATIENT SATISFACTION

TABLE 2 Pearson Product- Moment Correlation Coefficients between Self-ratings and Faculty Ratings of the Dimensions of Humanism

Self-rating

Faculty Rating Overall Verbal Respect Integrity Psychosocial Compassion Responsibility

Verbal communication 0.31 0.25 0.33 0.28 O. 13 0.29 0.24 Respect 0.26 0,11 0.20 0.40* 0.11 0,19 0.29 Integrity 0,42* 0.32 0.40* 0.37 0.27 0.34 0.44* Psychosocial 0.31 O. 17 0.24 0.31 0.32 0.36 0.31 Compassion 0.34 O. 17 0.24 0.31 0.32 0.36 0.31 Responsibility 0.002 0.09 - 0.08 0.06 - O, 17 - 0.08 0.02

OVERALL 0.34 0.22 0.27 0.39 O. 19 0.30 0.34

*p < 0.05.

between faculty ratings and self-ratings was 0.34 (Table 2). The residents' self-rating of integrity was the dimension most strongly correlated with the overall faculty rating (r = 0.42). It also correlated strongly with all other ratings of humanistic qualities by faculty members. The residents' self-rating of responsibility was the dimension that had the lowest correlation with all aspects of faculty ratings, including faculty rating of responsibility (r = 0.02) and overall score (r = 0.002). Spear- man's rank-order correlations produced estimates that were equivalent to or slightly lower than those produced by the Pearson correlations.

The patient satisfaction ratings for the ten questionnaire items are summarized in Table 3. On average, the patients cared for by the study residents rated their satisfaction with care as being very good (a rating of 4) to excellent (a rating of 5). There was no difference in patient satisfaction between the medical clinics in the two hospitals. The average interitem correlation for the patient questionnaire items was r = 0.9. Items receiving the lowest ratings related to the explanations provided to the patients by the residents (item 1 ) and to the effort made by the residents to engage the patients in decision making (item 7).

The reliability of patient satisfaction scores produced for the study residents was 0.65 (intraclass correlation coefficient) and the reliability of faculty ratings was 0.59. The correlations between patient satisfaction scores and self- and faculty ratings of humanism are shown in Table 4 along with 95% confidence intervals and beta estimates for the linear association between these two variables. The beta provides an estimate of the slope of the relationship. It can be seen that there was a significant positive association between faculty ratings of resident humanism and average patient satisfaction rating for a resident (r = 0.52). Faculty rating explained 27% of the variance in patient satisfaction ratings. For every point increase in faculty rating there was an increase of 0.1 to 0.2 of a point in patient satisfaction rating (about half of a standard deviation). Faculty rating of resident integrity was the dimension most strongly associated with patient rating (r = 0.58). In contrast to the significant correlations between faculty ratings and patient

satisfaction, self-ratings did not correlate well with patient satisfaction and explained only 5.8% of the variation in patient satisfaction scores. Although self-rating explained less of the variance in patient satisfaction ratings and was not statistically significant, trends similar to those seen with faculty ratings are present. Self-rating is positively but weakly related to patient satisfaction, and self-ratings of integrity and verbal ability were the humanistic dimensions most strongly linked to satisfaction rating. One reason for a stronger association between faculty ratings and patient satisfaction than between self-ratings and patient satisfaction might have been that different residents were included in these two analyses. We assessed this possibility by restricting the comparison of faculty and patient ratings to only those residents who completed self-ratings, and we found that the association was slightly weaker in this analysis; however, faculty ratings still explained significantly more of the variation in patient ratings ( r 2 = 20.4%) than did resident self-ratings (r 2 = 5.8% ).

We noted that among the residents in the bottom quartile of the distribution of patient satisfaction scores, 33% provided self:ratings of their humanistic qualities, which theoretically should have placed them in the upper quartile of patient satisfaction ratings, while 40% in" the upper quartile of patient satisfaction provided self- assessment scores in the lower two quartiles.

DISCUSSION

If, as critics claim, medical care is becoming de- humanized, it is laudable that organizations such as the American Board of Internal Medicine are attempting to emphasize the physician-pat ient relationship by devel- oping tools to assess humanistic and interpersonal skills as part of the certification process. Unfortunately, there are conflicting opinions in the literature about how to evaluate humanism and about who should do the evaluating. This serves to underscore the difficulties inherent in trying to quantify assessments that reflect qualitative judgments. Trying to evaluate residents' per- formances in the inpatient setting complicates the process even further because faculty evaluators' interactions

JOURNAL OF GENERAL INTERNAL MEDICINE, Volume 9 (June), 1994 325

with residents on the wards are no t ideally conduc ive to observation of their humanis t ic skills. Furthermore, patient satisfaction ratings canno t be relied upon as the sole inst rument for evaluat ion there, since inpatients may be unwilling to c o m m e n t candidly about satisfaction while they are under medical care. 25

In the cur rent s tudy w e c o m p a r e d pat ient satisfaction ratings and faculty humanism evaluations obta ined in the ambulatory sett ing and found a high corre la t ion between the two. We feel these pat ient satisfaction ratings are likely to be a m o r e accurate reflect ion of an individual resident 's pe r fo rmance than are those based in the inpatient setting. Ambulatory patients are not usually very ill and therefore are less likely to feel compel led to evaluate their caregivers highly. Fur thermore , we feel that ambulatory care faculty evaluators, including those in our study, are usually not w e d d e d to the cognit ive and technologic emphasis of ward-based medic ine and are often more consc ious of humanism and effective interpersonal skills. As a result, they are in an ideal po- sition to observe residents as they w o r k and interact with patients and coworkers . Another possible explanation for the high correlat ions be tween faculty ratings of humanism and patient satisfaction ratings in our s tudy may be the large n u m b e r of pat ient ratings w e acquired for each resident. As suggested earlier, o the r studies may have failed to de tec t g o o d correlat ions because of in- adequate numbers o f patient raters. "~ A third possibility is that the faculty raters in our sample w c r e a particularly percept ive g roup of individuals, well a t tuned to humanism of coworkers . We did not have adequate numbers of rates to assess this possibility. However , w e did note that the differences be tween faculty humanism ratings as predictors of pat ient satisfaction varied be tween 0 and 50%. Our results, and those repor ted by the Amer- ican Board of Internal Medicine, reveal high inter i tem correlations on the pat ient satisfaction questionnaire, suggesting that this quest ionnaire was assessing a single patient satisfaction factor.

It is no t ewor thy that resident self-ratings of humanism corre la ted less well with pat ient satisfaction rat-

TABLE 3

Patient Satisfaction Ratings (Mean _+ SD) for Each of Ten Questionnaire Items*

Satisfaction Questionnaire Items Rating

1. Telling you everything; being truthful, up-front, and frank; not keeping things from you that you should know 4.17 _+ 0.79

2. Greeting you warmly; calling you by the name you prefer; being friendly, never crabby or rude 4.22 _+ 0.79

3. Treating you like you're on the same level; never talking down to you or treating you like a child 4.24 _+ 0.77

4. Letting you tell your story; listening carefully, asking thoughtful questions, not interrupting you while you're talking

Showing interest in you as a person, not acting bored or ignoring what you have to say

Warning you during the physical exam about what he or she is going to do; asking what you think before telling you what to do

Discussing options with you; asking your opin- ion; offering choices and letting you help decide what to do; asking what you think before telling you what to do

Encouraging you to ask questions, answering them clearly, never avoiding your questions or lecturing you

Explaining what you need to know about your problems how and why they occurred and what to expect next

Using words you can understand when explaining your problems and treatment; explaining any technical medical terms in plain language

5.

6.

7.

8.

9.

10.

OVERALL VISIT RATING

4.23 _+ 0.79

4.24 _+ 0.78

4.19 -+ 0.79

4.18 _+ 0.80

4.19 + 0.82

4.21 + 0.80

4.23 _+ 0.78

4.21 _+ 0,75

*Patients rated each item on a five-point scale where 1 = poor, 2 - fair, 3 = good, 4 - very good, and 5 = excellent.

ings than did faculty ratings of residents ' humanism. The residents in this s tudy were conservat ive in their self- ratings. They used a m o r e res t r ic ted range of scale points than did the faculty, and this wou ld be likely to a t tenuate the magnitude of the correla t ion with patient satisfaction. In addition, those in the top and bo t tom quarti les

TABLE 4

Correlations between Patient Satisfaction Ratings and Self- and Faculty Ratings of Humanism

Correlation of Patient Satisfaction with Resident Correlation of Patient Satisfaction with Resident Scores Produced by Staff Ratings Scores Produced by Self-ratings

(n = 38 residents) (n = 29 residents) Humanistic

Quality r 95% CI* Beta p Value r 95% CI Beta p Value

0.43 (0.31 0.79) 0.1 0.008 0.34 ( -0 .30 -0 .74 ) 0.12 0.071 0.48 (0.19 0.85) 0.12 0.003 0.17 ( -0 .21 -0 .56 ) 0.04 0.366 0.58 (0.33 - 0.99) O. 17 0.0002 0.32 ( - 0.05 - 0.72) O. 13 O. 105 0.48 (0.19 0.85) 0.11 0.002 0 . 2 1 ( -0 .17 -0 .60 ) 0.06 0,504 0.48 (0. t7-0.83) 0.1I 0,002 0.21 ( -0 .17 0.60) 0.06 0.265 0.46 (0,25 - 0.91 ) 0,12 0,004 0.02 ( - 0.36 - 0.40) 0.006 0.922

0.52 (0.25 0.91) 0.14 0.001 0.24 ( -0 ,14 -0 .63 ) 0.10 0.209

Verbal Respect Integrity Psychosocial Compassion Responsibility

TOTAL

*CI = confidence interval.

326 McLeod et aL, RESIDENT HUMANISM RATINGS AND PATIENT SATISFACTION

of p a t i e n t r a t i n g m a y b e less p e r c e p t i v e a b o u t t h e i r abi l -

i t ies to e s t a b l i s h a n e f f e c t i v e p h y s i c i a n - p a t i e n t r e l a t i o n -

ship. T h e s e d i s c r e p a n t r e s u l t s s u g g e s t a n e e d fo r f u r t h e r

r e s e a r c h in t h i s area .

W e d o n o t k n o w w h y " i n t e g r i t y " w a s m o s t h i g h l y

p r e d i c t i v e o f p a t i e n t s a t i s f a c t i o n in f acu l ty e v a l u a t i o n a n d

s e l f - eva lua t i on o f h u m a n i s m , w h i l e " r e s p o n s i b i l i t y " w a s

m o s t p o o r l y c o r r e l a t e d . P e r h a p s " i n t e g r i t y " d e s c r i b e s

s o m e g l o b a l c h a r a c t e r i s t i c o f t h o s e r e s i d e n t s a b l e t o f o r m

g o o d p h y s i c i a n - p a t i e n t r e l a t i o n s h i p s , w h i l e " r e s p o n s i -

b i l i ty" d o e s no t . T h e l o w e r r a t i n g s g i v e n b y p a t i e n t s t o

r e s i d e n t s ' ab i l i t i e s t o e x p l a i n t h e i m p o r t a n t a s p e c t s o f

t h e i l lness a n d t o e n g a g e p a t i e n t s in t h e d e c i s i o n - m a k i n g

p r o c e s s h a v e b e e n r e p o r t e d p r e v i o u s l y , z6 P e r h a p s t h e s e

a reas n e e d m o r e e m p h a s i s in o u r t r a i n i n g p r o g r a m s .

Severa l r e s e a r c h e r s h a v e e x p l o r e d t h e u s e f u l n e s s o f

n u r s e e v a l u a t i o n s o f r e s i d e n t h u m a n i s m , t h e a r g u m e n t

b e i n g t h a t n u r s e s f r e q u e n t l y o b s e r v e r e s i d e n t s i n t e r a c t -

ing w i t h p a t i e n t s a n d t h e i r r e l a t i v e s . A l t h o u g h t h e r e a r e

n u m e r o u s p r o m i s i n g s t u d i e s u s i n g n u r s e s a n d p a r a m e d -

ical p e r s o n n e l , 27-32 i n t e r n a l m e d i c i n e p r o g r a m d i r e c t o r s

h a v e b e e n s l o w to a d o p t t h i s u n d e r u t i l i z e d i n f o r m a t i o n

r e s o u r c e .

In c o n c l u s i o n , w e a r e e n c o u r a g e d b y t h e r e s u l t s o f

o u r s t u d y o f p a t i e n t a n d f a c u l t y r a t i n g s o f n o n c o g n i t i v e

b e h a v i o r a l f e a t u r e s o f r e s i d e n t p e r f o r m a n c e , T h e co r -

r e l a t i o n s n o t e d a r e m u c h b e t t e r t h a n t h o s e h e r e t o f o r e

o b s e r v e d b y o t h e r r e s e a r c h e r s . A l t h o u g h w e n e e d c o n -

f i r m a t i o n o f t h e s e r e s u l t s f r o m o t h e r a m b u l a t o r y c a r e

p r o g r a m s , w e a r e i m p r e s s e d b y t h e s t r e n g t h w i t h w h i c h

facu l ty h u m a n i s m r a t i n g s p r e d i c t p a t i e n t s a t i s f a c t i o n ra t -

ings. T h e s e r e s u l t s m a y f u r t h e r e n c o u r a g e p r o g r a m di-

r e c t o r s to c o n t i n u e t h e p u s h to t h e a m b u l a t o r y s e t t i n g

for r e s i d e n t t r a i n i n g a n d e v a l u a t i o n . P e r h a p s a m i x o f

h u m a n i s m e v a l u a t i o n s f r o m b o t h a m b u l a t o r y c a r e fac-

u l ty a n d n u r s e s w i l l p r o v i d e t h e m o s t v a l u a b l e in for -

m a t i o n fo r u s e in f e e d b a c k to r e s i d e n t s .

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faculty ratings of resident humanism predict patient satisfaction ratings in ambulatory medical...

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