Rationale and Objectives
Patient-centered healthcare delivery has become increasingly established as a cornerstone of quality medical care, but teaching these principles in a radiology residency setting is often difficult and ineffective in a traditional lecture format. We developed a novel educational session in which actual patient letters about a healthcare provider are used to facilitate a case-based discussion of key principles of patient-centered care.
Materials and Methods
A novel patient letter-facilitated, case-based session was conducted at two different university-based teaching institutions. Prior to the educational session, patient letters introducing the principles of patient-centered care were distributed to residents for review. During the session, radiology-specific cases were discussed in the context of the principles introduced by the letters. A post-session survey was administered to evaluate the efficacy and usefulness of the session.
Results
Forty-six of the 61 session attendees (75%) completed the post session survey. Most respondents (93%) preferred this case-based, interactive session to a typical didactic session. A majority of the residents indicated that both the patient letters (64%) and radiology specific cases (73%) helped them think differently about how they interact with patients. They indicated that the session enhanced their understanding of professionalism (3.7 out of 5.0 [95% CI 3.4–4.0]) and increased their motivation to become more patient-centered (3.0 out of 4.0 [95% CI 2.8–3.3]).
Conclusions
Our findings suggest that patient letter-facilitated, case-based sessions may influence resident attitudes regarding the principles of patient-centered care and may help to increase resident motivation to become more patient-centered in their own practice.
Introduction
Patient-centered healthcare delivery has become increasingly accepted as a cornerstone of safe and high-quality medical care . The Institute of Medicine includes patient-centered care as one of its six principles of quality health care . Because of the increasing importance of patient-centered care in the practice of modern medicine, the Accreditation Council for Graduate Medical Education (ACGME) now includes its teaching as an essential component of resident training, under the purview of the core competency of professionalism .
The term “patient-centered care” was introduced into the medical lexicon in 1988 by the Picker/Commonwealth Program for Patient-Centered Care . A few years later, the Picker Institute elaborated on this concept, identifying several characteristics of health care that have come to be identified as core principles of patient-centered care. These core principles include (1) respect for patient values, preferences, and expressed needs; (2) coordinated and integrated care; (3) clear communication between patient and provider, including education for the patient and family; (4) physical comfort, including pain management; (5) emotional support and alleviation of fears and anxiety; (6) involvement of family members and friends, as appropriate; and (7) continuity of care, including during transitions between sites of care .
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Materials and Methods
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
TABLE 1
Post-Assessment Patient-Centered Care Survey
Format of the Session Number/Respondents (%) How helpful was it to preview the letters by e-mail prior to the session? A. Not at all helpful 3/45(3.0) B. Somewhat helpful 25/45(55.6) C. Very helpful 17/45(37.8) Was it helpful to preview the radiology-specific case scenario prior to the session? A. Not at all helpful 2/45(4.4) B. Somewhat helpful 26/45(57.8) C. Very helpful 17/45(37.8) How helpful was the open discussion format useful for this topic? A. Not at all helpful 1/45(2.2) B. Somewhat helpful 19/45(42.2) C. Very helpful 25/45(55.6) Would you have preferred a didactic format? A. Yes 3/46(6.5) B. No 43/46(93.5) Listening to others speak about their experiences was useful. A. Definitely yes 20/46(43.5) B. Somewhat yes 24/46(52.2) C. Neutral 2/46(4.3) D. Not really comfortable 0/46(0.0) E. Definitely no 0/46(0.0) Was there sufficient time to review the letters and case-specific scenario prior to the session? A. Yes 43/46(93.5) B. No 3/46(6.5) Was the time appropriate for the session? A. Too much 3/46(6.5) B. Just right 43/46(93.5) C. Too little 0/46(0.0)
Learning Environment Number/Respondents (%) I felt comfortable speaking about my own experiences related to this topic. A. Definitely yes 22/44(50.0) B. Somewhat yes 16/44(36.4) C. Neutral 5/44(11.4) D. Not really comfortable 1/44(2.3) E. Definitely no 0/44(0.0) Did the microphone(or the knowledge that you would be recorded) inhibit your participation in any way? A. Yes a lot 1/45(2.2) B. Yes somewhat 7/45(15.6) C. Not really 25/45(55.6) D. Not at all 12/45(26.7) Did you feel safe discussing your opinion openly with the program directors present? A. Yes completely 28/46(60.9) B. Yes to some extent 17/46(37.0) C. Not really 1/46(2.2) D. Not at all 0/46(0.0) Would you prefer to have the session facilitated by a peer or non-involved professional? A. Yes 10/45(22.2) B. No 35/45(77.8)
Efficacy of the Session Number/Respondents (%) Did the letters help you to think differently about how you might want to interact with patients? A. Yes to a great extent 5/44(11.4) B. Yes somewhat 23/44(52.3) C. Not really 16/44(36.4) D. Not at all 0/44(0.0) Did the radiology-specific case scenario help you think differently about how you might interact with patients? A. Yes to a great extent 6/45(13.3) B. Yes somewhat 27/45(60.0) C. Not really 12/45(26.7) D. Not at all 0/45(0.0)Mean(95% CI)Rate 1–5 scale(1 Not at all, 2 Not really, 3 Neutral, 4 Somewhat, 5 Definitely) This session focused on the importance of patient-centered radiology. 4.36(4.15–4.56) This session made me reflect on my own values. 4.27(4.05–4.49) This session made me think about radiology in a way I have not done. 3.18(2.83–3.53) This session added to my understanding of professionalism. 3.69(3.40–3.97) I will apply what I learned in this session to my residency training. 4.11(3.87–4.35) This session was worth my time. 4.18(3.92–4.44)
Professionalism Topics Attitudes Regarding Importance of the Topic Mean(95% CI)Rate 1–5 scale(1 Not at all important, 2 Unimportant, 3 Neutral, 4 Important, 5 Extremely important) How important is this session topic to radiology in general? 4.07(3.90–4.24) How important is this session topic to radiology residency? 4.05(3.87–4.23) How important is this session topic to your future career? 4.18(4.01–4.35)
Motivational Impact of This Session Mean(95% CI)Rate 1–4 scale(1 Not at all, 2 Not really, 3 Somewhat, 4 Definitely) As a result of participating in this session, I will change how I interact with patients. 2.78(2.56–2.99) As a result of participating in this session, I will actively find ways to become more patient centered. 3.05(2.83–3.26) As a result of participating in this session, I will be more available to my patients in order to convey test results or explain imaging findings. 3.27(3.08–3.46) As a result of participating in this session, I will take a more active role in patient care. 3.33(3.14–3.53)
Attitudes Regarding Physician Characteristics Mean(95% CI)Rate 1–5 scale(1 Strongly disagree, 2 Disagree, 3 Neutral, 4 Agree, 5 Strongly agree) Honesty is an important trait in physicians. 4.78(4.57–4.98) Being available to patients is important. 4.64(4.49–4.80) Being available to referring physicians for consults is important. 4.71(4.54–4.88) Cultural differences play an important role when conveying test results. 4.59(4.40–4.79)
Free Response/Suggestions Name at least two strengths of this session. Name at least two weaknesses of this session. This session could be improved by: Any other thoughts or suggestions:
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Results
Get Radiology Tree app to read full this article<
TABLE 2
Demographics of the Respondents
Respondent Demographics Postgraduate Year of Training Number/Respondents (%) PGY-2 15/46 (32.6) PGY-3 11/46 (23.9) PGY-4 10/46 (21.7) PGY-5 10/46 (21.7)
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Discussion
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Appendix. Excerpts From Three Patient Letters
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
Get Radiology Tree app to read full this article<
References
1. McMillan S.S., Kendall E., Sav A., et. al.: Patient-centered approaches to health care: a systematic review of randomized controlled trials. Med Care Res Rev 2013; 70: pp. 567-596.
2. Richards T., Coulter A., Wicks P.: Time to deliver patient centred care. BMJ 2015; 350: pp. h530.
3. Parish E.: BMJ roundtable debate: how can we get better at providing patient centred care?. BMJ 2015; 350: pp. h412.
4. Committee on Quality of Health Care in America , Institute of Medicine : Crossing the quality chasm: a new health system for the 21st century.2001.National Academy PressWashington, DC
5. Ludwig S., Day S.: New standards for resident professionalism: discussion and justification.Philibert I.Amis S.The ACGME 2011 duty hour standard.2011.Accreditation Council for Graduate Medical EducationChicago, IL:pp. 47-51.
6. Barry M.J., Edgman-Levitan S.: Shared decision making—pinnacle of patient-centered care. N Engl J Med 2012; 366: pp. 780-781.
7. Gerteis M.Edgman-Levitan S.Daley J. et. al.Through the patient’s eyes: understanding and promoting patient-centered care.1993.Jossey-BassSan Francisco, CA:
8. Rathert C., Wyrwich M.D., Boren S.A.: Patient-centered care and outcomes: a systematic review of the literature. Med Care Res Rev 2013; 70: pp. 351-379.
9. Record J.D., Rand C., Christmas C., et. al.: Reducing heart failure readmissions by teaching patient-centered care to internal medicine residents. Arch Intern Med 2011; 171: pp. 858-859.
10. Ratanawongsa N., Federowicz M.A., Christmas C., et. al.: Effects of a focused patient-centered care curriculum on the experiences of internal medicine residents and their patients. J Gen Intern Med 2012; 27: pp. 473-477.
11. Moncayo V.M., Applegate K.E., Duszak R., et. al.: The nuclear medicine therapy care coordination service: a model for radiologist-driven patient-centered care. Acad Radiol 2015; 22: pp. 771-778.
12. American College of Radiology : Imaging 3.0. Available at: http://www.acr.org/Advocacy/Economics-Health-Policy/Imaging-3 Cited January 20, 2016
13. Smith-Bindman R., Miglioretti D.L., Johnson E., et. al.: Use of diagnostic imaging studies and associated radiation exposure for patients enrolled in large integrated health care systems, 1996–2010. JAMA 2012; 307: pp. 2400-2409.
14. Pahade J., Couto C., Davis R.B., et. al.: Reviewing imaging examination results with a radiologist immediately after study completion: patient preferences and assessment of feasibility in an academic department. AJR Am J Roentgenol 2012; 199: pp. 844-851.
15. Brown S.D., Lehman C.D., Truog R.D., et. al.: Stepping out further from the shadows: disclosure of harmful radiologic errors to patients. Radiology 2012; 262: pp. 381-386.
16. Berlin L.: Communicating results of all radiologic examinations directly to patients: has the time come?. AJR Am J Roentgenol 2007; 189: pp. 1275-1282.
17. Knight J.K., Wood W.B.: Teaching more by lecturing less. Cell Biol Educ 2005; 4: pp. 298-310.
18. Freeman S., Eddy S.L., McDonough M., et. al.: Active learning increases student performance in science, engineering, and mathematics. Proc Natl Acad Sci U S A 2014; 111: pp. 8410-8415.
19. Huddle T.S., Accreditation Council for Graduate Medical Education (ACGME): Viewpoint: teaching professionalism: is medical morality a competency?. Acad Med 2005; 80: pp. 885-891.
20. McGinty K.L., Larson J.J., Hodas G., et. al.: Teaching patient-centered care and systems-based practice in child and adolescent psychiatry. Acad Psychiatry 2012; 36: pp. 468-472.
21. Chapman T., Chew F.S.: Introductory lecture series for first-year radiology residents: implementation, investment and assessment. Acad Radiol 2013; 20: pp. 332-337.
22. Hochberg M.S., Kalet A., Zabar S., et. al.: Can professionalism be taught? Encouraging evidence. Am J Surg 2010; 199: pp. 86-93.
23. Donnelly L.F., Strife J.L.: Establishing a program to promote professionalism and effective communication in radiology. Radiology 2006; 238: pp. 773-779.
24. Hendee W., Bosma J.L., Bresolin L.B., et. al.: Web modules on professionalism and ethics. J Am Coll Radiol 2012; 9: pp. 170-173.
25. Radiological Society of North America : Professionalism modules. Available at: http://www.rsna.org/Professionalism/ Cited January 8, 2016
26. Christianson C.E., McBride R.B., Vari R.C., et. al.: From traditional to patient-centered learning: curriculum change as an intervention for changing institutional culture and promoting professionalism in undergraduate medical education. Acad Med 2007; 82: pp. 1079-1088.
27. Meo S.A.: Evaluating learning among undergraduate medical students in schools with traditional and problem-based curricula. Adv Physiol Educ 2013; 37: pp. 249-253.
28. Reed S., Shell R., Kassis K., et. al.: Applying adult learning practices in medical education. Curr Probl Pediatr Adolesc Health Care 2014; 44: pp. 170-181.
29. Bethune C., Brown J.B.: Residents’ use of case-based reflection exercises. Can Fam Physician 2007; 53: pp. 471-476. 470
30. Kung J.W., Slanetz P.J., Huang G.C., et. al.: Reflective practice: assessing its effectiveness to teach professionalism in a radiology residency. Acad Radiol 2015; 22: pp. 1280-1286.
31. Metter D., Harolds J., Rumack C.M., et. al.: The disruptive professional case scenarios. Acad Radiol 2008; 15: pp. 494-500.
32. Kung J.W., Eisenberg R.L., Slanetz P.J.: Reflective practice as a tool to teach digital professionalism. Acad Radiol 2012; 19: pp. 1408-1414.