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Posted March 05, 2015

Connecting the Dots between Residency Training, Accreditation Requirements and Patient Experience

By Barbara Roehl, MD, MBA

Residents have a tremendous impact on the patient experience. Through their interactions with patients, residents impact CAHPS results of attending faculty and the organization as a whole. The changing healthcare environment ensures that the patient experience as a driver of reimbursement is here to stay. Therefore, to improve outcomes and appropriately prepare learners for this new reality, teaching hospitals have an incentive and obligation to teach, validate, and hold learners accountable for their role in the patient experience.

In an effort to enhance the ability of physicians to practice in the 21st Century, the Accreditation Council for Graduate Medical Education (ACGME) is moving toward accreditation on the basis of results or educational outcomes. The Next Accreditation System (NAS) creates new expectations for Clinical Learning Environment Review (CLER) accreditation site visits and demonstration of specialty specific Milestones along the path to achieving Core Competencies. Due to the new ACGME requirements for residency programs, now is the time to integrate patient experience into resident curriculum and oversight. 

While the ACGME requirements have changed, we work with organizations to adapt to change and positively impact results through implementing specific tactics and tools. Below are just two recommendations that when implemented, can have a significant impact on patient experience.

AIDET®
Organizations that implement a communication framework for physicians, such as AIDET®, can ease patient anxiety and increase compliance. The positive outcomes apply to faculty as well as learners. It also directly impacts the ACGME Core Competency of Interpersonal Communication Skills.

AIDET® stands for Acknowledge, Introduction, Duration, Explanation, and Thank You, and is proven to decrease patient anxiety and improve compliance. In addition to sharing your AIDET®, here are a few tips for providers:

  • Shake hands with patients and family members to demonstrate courtesy and respect.
  • Sit down during patient interactions. It increases the patient’s perception of time spent with them.
  • Manage up co-workers, residents and hospital staff. This demonstrates coordination of care and reassures patients they have a team of care givers that cares about them.

Learn more by downloading these guidelines.

Role Play and Shadowing
We also recommend direct observation and validation of skills by Program Directors and faculty through role play and shadow rounding. To be successful in improving interpersonal communication skills, residency programs can actively enroll faculty and residents in the process so everyone receives the same training. It’s important to link the skills to clinical outcomes and the patient experience, as well as pressures from the external environment (e.g. CAHPS, malpractice risk). The training should be real and relevant, and hands on. A key component of the training is ongoing validation through shadow rounding.

Assessment of ACGME Milestones requires direct observation of the resident in the workplace.   As such, a program of assessment should be embedded as part of curriculum planning. The observational feedback around interpersonal and communication skills can serve as one more source of input for the Clinical Competence Committee to review in making an overall decision on how the resident is progressing toward mastery of the Core Competencies.

Training and development for residents ensures they are providing the same level of quality care that we expect from our faculty. This investment shows residents that the organization is fully committed and dedicated to improving patient experiences. At the same time, it also ensures that accreditation requirements are met.

Additional Resources:

Studer Conferences offer how-to workshops on a variety of topics. See “what right looks like” with active role playing and develop an action plan and immediate next steps. Learn more at www.studergroup.com/conferences.

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