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

ResidentPatient 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 (4.48) (12.12) Counseling Skills f (2.99) (11.93) Patient Response g (1.49) (1.53) a. (Range = 0-105); b. (Range = ); c. (Range = 1-10); d. (Range = ); e. (Range = ); f. (Range = 7-70); g. (Range = 4-40) Ratings of patientphysician 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 (11.81) (9.26) (9.52) (16.53) Jefferson Physician Empathy b (1.21) (3.82) Self-Report Stress Rating c 6.67 (4.16) 6.58 (4.12) 4-Habits Scale d (7.75) (10.40) (5.69) (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): May  Frankel RM, Stein T. Getting the Most out of the Clinical Encounter: The Four Habits Model. J Med Pract Management, 16(4): Jan-Feb  Hojat M, et. al. The Jefferson Scale of Physician Empathy: Develppment and Preliminary Psychometric Data. Educ Psychol Measurement, 61: