THE EFFECT OF MEDICAL-EDUCATION ON STUDENTS PATIENT-SATISFACTION RATINGS

Purpose. To determine whether medical students' inter personal and com munication skills, as measured by satisfaction ratings given by standa rdized patients (SPs), im proves or deteriorates with additional train ing and experience. Method. A longitudinal study was made of a single cohort of 133 medical students scheduled to graduate in 1994 from the University of Illinois College of Medicine at Chicago. Clinical perfor mance examinations employing clinical encounters with SPs were given a t the end of the students' second year and at the end of the first qua rter of their fourth year. The second-year examination consisted of fo ur student-SP encounters for each student; the fourth-year examination consisted of 16 such encounters. For each examination, SP perceptions of interpersonal and communication skills were measured using six ite ms from the American Board of Internal Medicine Patient Satisfaction Q uestionnaire; the items employed five ordinal-scale descriptors (from 1 = poor to 5 = excellent). The unit of analysis was the student-SP en counter. For each year, ratings on each item were averaged across en c ounters td produce a mean rating for each item; in addition, ratings a cross all the encounters and items were averaged to produce a mean tot al patient satisfaction rating. The percentage of fail or poor ratings given for each item was calculated, as was the average of these perce ntages across the items. All rating calculations were done between yea rs and between genders. Two-tailed, paired t-tests and F-ratios were u sed for comparisons between years and between genders, respectively. F inally, ratings for a comparison group of first-, second-, and third-y ear internal medicine residents were gathered under similar testing co nditions. Results. Mean total patient satisfaction with the students' clinical performances improved from the first examination (3.51, SD,.8 4) to the second (3.60, SD,.86). The percentage of student encounters receiving fair or poor ratings decreased from 14.5% in the second year to 12% in the fourth year; resident encounters received a fair or poo r rating 7.8% of the time. The female students received fewer fair or poor ratings than did the male students both in their second year (11. 7% vs 16%) and in their fourth year (9.3% vs 12.8%). Of the six patien t-satisfaction items, both the students and the residents consistently were ranked lowest in encouraging patients to ask questions and answe ring patient questions. Conclusion. Contrary to the stated beliefs of some physician-educators that students' skills deteriorate during the course of training, these medical students' interpersonal and communic ation skills improved with additional training and experience.