Impact of supervision and self-assessment on doctor-patient communication in rural Mexico (PDF)
Kim,Young-Mi; Figueroa,Maria Elena; Martin,Antonieta; Silva,Ricardo; Acosta,Sixto F.; Hurtado,Manuel; Richardson,Paul; Kols,Adrienne
International Journal for Quality in Health Care 14(5): 359-367
Publication date: 2002
To determine whether supervision and self-assessmentactivities can improve doctor-patient communication.
Setting and participants
Six supervisors, 60 doctors in theirlast year of training, and 232 primary health care patientsat rural health clinics in Michoacan, Mexico.
The main evaluation compared post-intervention measuresin control and intervention groups. A small panel study alsoexamined changes from baseline to post-intervention rounds inboth groups.
Over a 4-month period, specially trained supervisorsadded 1 hour of supervision on interpersonal communication andcounseling (IPC/C) to regular site visits. Doctors, who hadreceived prior IPC/C training, periodically audiotaped and assessedtheir own consultations.
Main outcome measures
These comprised frequency of doctors'facilitative communication, doctors' biomedical information-giving,and patients' active communication.
The performance of all doctors improved markedly overthe study period, but gains in facilitative communication andinformation-giving were significantly greater in the interventionthan the control group. No single component of the interventionwas responsible for the improvement; it resulted from the combinationof activities. The doctors appreciated the more supportive relationshipwith supervisors that resulted from the intervention and foundlistening to themselves on audiotape a powerful, although initiallystressful, experience.
Supportive supervision and self-assessment activitiescan reinforce IPC/C training, prompt reflection and learning,and help novice doctors improve their interpersonal communicationskills.