EVALUATION OF THE COUNSELING PRACTICUM AS AN EFFECTIVE METHOD TO TEACH COUNSELING SKILLS TO DOCTORS

Mary Dankoski, Ph.D.Shobha Pais, Ph.D.Kathy Zoppi, Ph.D., M.P.H.Scott Renshaw, M.D. Dustin Wright, M.S.

OBJECTIVES

Attendees will understand… The unique elements of practicum for

training in counseling and communication skills

How we conduct practicum sessions Pilot results from research evaluating

the effectiveness of the practicum curriculum

Communication in Family Medicine

“Black Box” study (Stange et. al., 1998)

Family assessment – 73% Answering patient questions – 71% Negotiation – 21% Counseling – 16% Patient Education – 18-26%

70% of mental health problems are treated by primary care physicians

Methods for Teaching Communication and Counseling Skills

Didactic sessions Standardized patients Role play Video tape review Co-counseling sessions Observed counseling sessions

Practicum Curriculum Goal

The goal of the practicum training is to improve resident physician communication and counseling skills through supervised counseling of patients by peers and behavioral faculty preceptors.

Practicum Format

Pre-session (10-15 minutes) Resident counsels patient (20-25) Mid-session break (10-15) Resident counsels patient (20-25) Post-session (10-15)

METHODS

Pre-practicum questionnaires for both patient and resident

Post-practicum questionnaires for both patient and resident

Video tape coding of communication and counseling skills in both practicum sessions and “typical” medical encounters from PGY I (prior to start of practicum training)

MEASURES

Agnew Relationship Measure (Agnew-

Davies, et. al., 1998) – Constructs: Bond Partnership Confidence Openness Patient initiative

Patient stress rating

MEASURES

Four Habits (Frankel et. al., 2001) Assessment of Communication Skills in Medical Encounters:

Invest in the beginning Elicit the patient’s perspective Demonstrate empathy Invest in the end

MEASURES

Jefferson Scale of Physician Empathy (Hojat, et. al., 2001) ‘…developed to measure the empathetic qualities

and tendencies among health care students and professionals.” Items assessing:

Empathetic concern Perspective taking Warmth Dutifulness Global sympathy Compassion Trust Tolerance Personal growth Humor Self-protection Clinical neutrality

MEASURES

Pais Physician Rating Scale Physician counseling skills – Constructs:

Support Acceptance Understanding Genuineness Provide information Collaborative

Patient response rating – Constructs: Affect Cooperation Disclosures Engagement

 Resident Patient

Pre-Counseling Practicum Training

• Two videotapes from PGYI coded with 4-Habits Coding Scheme and Pais Physician Scale• Confidence in Counseling Skills• Jefferson Physician Empathy Scale 

 

Post-Counseling Practicum Training

• Confidence in Counseling Skills• Jefferson Physician Empathy Scale 

 

Immediately prior to each counseling session

• Agnew Relationship Measure• Jefferson Physician Empathy Scale

• Agnew Relationship Measure• Stress Questionnaire

Immediately after each counseling session

• Agnew Relationship Measure• Key Moments Questionnaire• 4-Habits Self-Report Version• Jefferson Physician Empathy Scale

• Agnew Relationship Measure• Key Moments Questionnaire• 4-Habits Patient-Report Version• Stress Questionnaire

Tapes of Counseling Sessions

• 4 videotaped counseling sessions per resident are coded with the 4-Habits Coding Scheme and Pais Physician Rating Scale.

 

Pais Physician Rating Scale e 82.92 (4.48) 90.00 (12.12)

Counseling Skills f 49.44 (2.99) 56.67 (11.93)

Patient Response g 33.47 (1.49) 33.33 (1.53)

a. (Range = 0-105); b. (Range = 20-140); c. (Range = 1-10); d. (Range = 20-100); e. (Range = 11-110); f. (Range = 7-70); g. (Range = 4-40)

Ratings of patient physician relationship and resident counseling skills as rated by patient, resident, and

independent rater (N = 3).

Measure Medical Encounters

Rating M (SD)

Immediately Prior to Counseling Immediately After Counseling

Practicum Videotape

Rating M (SD)

Patient M (SD)

Resident M (SD)

Patient M (SD)

Resident M (SD)

Agnew Relationship Scale a 95.06 (11.81) 73.50 (9.26) 95.83 (9.52) 71.72 (16.53)

Jefferson Physician Empathy b 108.61 (1.21) 106.83 (3.82)

Self-Report Stress Rating c 6.67 (4.16) 6.58 (4.12)

4-Habits Scale d 65.28 (7.75) 92.94 (10.40) 83.67 (5.69) 73.33 (9.61)

RESULTS

TRENDS

Differences in patient/physician perceptions of relationship

Improvements in the effectiveness of physician/patient encounters from first year

Improvement in physicians’ counseling skills from first year

REFERENCES

Agnew-Davies, Roxane Stile, William B. Hardy, Gillian E. Barkham, Michael Shapiro, David A. Agnew Relationship Measure. British J of Clin Psychology, 37(2): 155-72. May 1998.

Frankel RM, Stein T. Getting the Most out of the Clinical Encounter: The Four Habits Model. J Med Pract Management, 16(4): 184-91. Jan-Feb 2001.

Hojat M, et. al. The Jefferson Scale of Physician Empathy: Develppment and Preliminary Psychometric Data. Educ Psychol Measurement, 61:349-65. 2001.