Effectiveness of a Multifaceted Program to Improve Interpersonal Skills of Physicians in Medical Consultations. A Randomized Controlled Trial (EPECREM)
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 146
- 试验地点
- 1
- 主要终点
- Four-Habits-Coding-Scheme scale score
研究概览
简要总结
To determine whether the implementation of a multifaceted training program relying on the conceptual framework of the Four Habits Model improved the communication and interpersonal skills for hospital physicians during consultations compared with control physicians receiving no intervention, the investigators will conduct a prospective randomized, controlled, open-label, two parallel arms, superiority interventional trial. The unit of randomization is the physician.
详细描述
Rationale: Interpersonal skills, encompassing communication and empathy, are key components of effective medical consultations and represent physician core competences that are most desired by patients. High-quality communication relates with enhanced patient satisfaction, greater adherence to treatment, better health outcomes, and decreased risk of malpractice claims. Many organizations have therefore implemented structured training programs to improve physician communication skills in North America and Europe. Yet limited evidence exists on the effectiveness of these programs in improving physician interpersonal skillsMost studies used unvalidated instruments that may not accurately reflect interpersonal skills, were underpowered to detect clinically meaningful differences in interpersonal skills due to relatively limited sample size, lacked a control group, or used a study design that was prone to evaluation bias. In addition, few studies examined whether these training programs dedicated to improve physician communication skills altered patient satisfaction therapeutic alliance or modified physician self-efficacy and professional achievement.
The "Four Habits Model" is a training program that has been developed within the US Health Maintenance Organization Kaiser Permanente and implemented for teaching effective communication to thousands of clinicians in this organization over the two last decades. The Four Habits Model refers to basic medical interview tasks that are organized within four dimensions, namely, Invest in the beginning, Elicit the patient's perspective, Demonstrate empathy, and Invest in the end. Since its development, the Four Habits Model has been successfully implemented outside the Kaiser Permanente system, in various settings in North America and Western Europe.
Our research team recently carried out the cross-cultural adaptation of the Four Habits Coding Scheme (4-HCS) scale into French. The 4-HCS is a standardized instrument designed to assess physician communication skills from an external rater's perspective, relying on the conceptual framework of the Four Habits Model.
The investigators hypothesize that the implementation of a multifaceted training program based on the Four Habits Model improved physician interpersonal skills without altering consultation duration, increased patient satisfaction and therapeutic alliance, and modified physician self-efficacy and professional achievement.
Primary objective: To determine whether the implementation of a multifaceted training program relying on the conceptual framework of the Four Habits Model improved the communication and interpersonal skills for hospital physicians during consultations compared with control physicians receiving no intervention.
研究设计
- 研究类型
- Interventional
- 分配方式
- Randomized
- 干预模型
- Parallel
- 主要目的
- Other
- 盲法
- Single (Outcomes Assessor)
盲法说明
In this open label trial, the participating physicians will not be blinded to allocation. Only the physicians who will rate video-recorded consultations and the statistician will be blinded to study arm.
入排标准
- 年龄范围
- 18 Years 至 —（Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 是
入选标准
- •Physicians:
- •Physicians board-certified in medical, surgical, or gynaecology-obstetrics specialty at Grenoble Alpes University Hospital
- •Provision of written informed consent
- •Scheduled consultation in the public sector at Grenoble Alpes University Hospital
- •Patient treated in the participating physician's department
- •Initial consultation for new patient
- •Age ≥18 years old
排除标准
- •Physicians:
- •Problems expressing or understanding the French language for cultural or language reasons
- •Problems expressing or understanding the French language for cultural or language reasons
- •Patients who are unable to provide written informed consent, because of cognitive impairment, altered mental status, or communication impairments for medical reason
- •Patient subject to a legal protection measure or unable to express their objection
结局指标
主要结局
Four-Habits-Coding-Scheme scale score
时间窗: The primary outcome measure will be the mean difference in the 4-HCS score at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).
The primary outcome measure is the overall 4-HCS scale score. This score is computed by summing ratings for the 4-HCS individual items, ranging from 23 (i.e., less effective) to 115 (i.e., more effective). Two physicians blinded to study arm will independently rate video-recorded medical consultations using the 4-HCS. To account for inter-rater variability, we will computed average 4-HCS overall rating scores.
次要结局
- American Board of Internal Medicine's Patient Satisfaction Rating Scale(The outcome measure will be the mean difference in the score at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).)
- Therapeutic Alliance Inventory scale(The outcome measure will be the mean difference in the score at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).)
- Duration of medical consultation(The outcome measure will be the mean difference in the duration at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).)
- 4-HCS subscale scores(The outcome measure will be the mean difference in the score at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).)
- Maslach Burnout Inventory multidimensional scale(The outcome measure will be the mean difference in the score at a 3-month interval between the first (3-month period beginning on date of randomization) and second wave of consultations (3-month period beginning on date of intervention).)