Communication Deficits Among Surgical Residents During Difficult Patient Family Conversations

Abstract

Objectives: To qualitatively analyze videotaped data of surgical residents and fellows interacting with standardized patients to identify communication weaknesses. To correlate our qualitative data with their quantitative scores.

Design: We used discourse analysis to identify negative communication patterns among 10 surgical residents and fellows who were tested on interpersonal competencies during an objective structured clinical examination in 2014. We then correlated our findings with the validated evaluation outcomes. Descriptive statistics were then used to quantify our findings.

Setting: The setting was an objective structured clinical examination performed in 2014 using standardized patient surrogate family members.

Participants: The participants were a mix of first and third year surgical residents and critical care fellows.

Results: The item that most strongly differentiated the bottom 5 from the top 5 performers was not answering the patient appropriately. This was exhibited in 3 ways among the lowest performers in our study: (1) paternalism, (2) vagueness, and (3) dehumanization. Our statistical analyses showed that the overall number of negative communication behaviors correlated with negative staff scores (r = -0.653, p < 0.05). Dehumanization and paternalism were the 2 behaviors most strongly correlated with negative staff scores (r = 0.796 and 0.781 respectively, p < 0.01).

Conclusions: We found the lowest performers responded inappropriately to the patient, which we further delineated into vagueness, paternalism, and dehumanization. We propose positive communication strategies be taught to residents to improve how they are perceived by patients.

Keywords: Difficult Conversations; Discourse Analysis; Interpersonal and Communication Skills; Negative Communication Patterns; Patient Care; Patient-Centeredness; Professionalism.