TEMPLATE AND PRINTING BY: GRMERC Consortium Members: Grand Valley State University, Michigan State University, Saint Mary’s Health Care, & Spectrum Health Using Patient Satisfaction Surveys to Assess Resident Competencies in Providing the Personal Medical Home John E. vanSchagen, MD, FAAFP GRMERC/MSU Family Medicine Residency Introduction Study Procedures Study Objectives Conclusions & Implications References Quality and safety are hallmarks of the personal medical home. The Joint Principles of the Patient-Centered Medical Home state that patients should actively participate in decision- making, and feedback should be sought to ensure patients’ expectations are being met. 1 The TransforMED project includes patient satisfaction feedback as a key component of quality and safety. 2 At the same time, the Accreditation Council for Graduate Medical Education (ACGME) has mandated the training and evaluation of residents in certain general core competencies to ensure their ability to practice medicine in the changing health care delivery system. 3 Study Design Participants 144 patients, age 18 years and older, seen at the GRMERC/MSU Family Medicine residency clinic from 4/1/08 through 6/1/08. Twenty-five residents were evaluated during the survey period. Patients were asked to voluntarily complete an anonymous PSS addressing the following: Listening (L) Knowledge (K) Communication (C) Professionalism (P) Overall satisfaction (OS) Outcomes were measured as levels of satisfaction on a 5-point scale (1=excellent, 5=very poor). Outcomes were calculated separately for the four satisfaction subscales and overall satisfaction. All residents were given their individual PSS results during matriculation sessions following the study. A post-survey questionnaire was sent to all residents to assess the impact on their behaviors and attitudes related to the process of patient satisfaction data collection and analysis. Differences between year classes for ordinal data were compared using the Kruskal-Wallis ANOVA, while analyses for nominal data were compared using the  2 and Fisher’s Exact tests. Significance was assessed at p<0.05. Results The median program scores were 1 for each of the five categories. Analysis by class yielded no statistically significant differences in scores between program year levels on the various subscales. However, there appeared to be an upward trend in the Communication subscale with increasing year level (Fig. 1). Residents reported that they felt patients had medium to high abilities in judging resident competencies, and that their behaviors were likely to show positive change in future encounters (Fig. 2). 62.5% of residents felt that patient satisfaction was extremely valuable to their residency practice, while 75% felt it would be extremely valuable to future private practice (Fig. 3). Discussion 1.American Academy of Family Physicians, American Academy of Pediatrics, American College of Physicians, American Osteopathic Association. Joint principles of the patient-centered medical home. March Accessed Sept. 5, 2008, at: TransforMED. The TransforMED Medical Home Model. Accessed Sept. 5, 2008, at: Accreditation Council for Graduate Medical Education. Common program requirements: General Competencies. February Accessed Sept. 5, 2008, at: Monk SM, Nanagas MT, Fitch JL, et al. Comparison of resident and faculty patient satisfaction surveys in a pediatric ambulatory clinic. Teach Learn Med Fall;18(4): Yancy WS Jr, Macpherson DS, Hanusa BH, et al. Patient satisfaction in resident and attending ambulatory care clinics. J Gen Intern Med Nov;16(11): Jagadeesan R, Kalyan DN, Lee P, et al. Use of a standardized patient satisfaction questionnaire to assess the quality of care provided by ophthalmology residents. Ophthalmology Apr;115(4): Using our PSS to measure three of the ACGME general competencies and overall patient satisfaction, we found that patients were highly satisfied with family medicine resident care. However, using such a tool may not allow the comparison of competencies for individual residents. Residents report that such feedback has a positive influence on their behaviors and attitudes during encounters with patients. Interestingly, residents feel patient feedback will be more important in private practice than in training. This may reflect the level of ownership residents feel toward their continuity patients versus their perceived responsibilities as future attendings. Significance The GRMERC/MSU Family Medicine Residency Program developed a standardized patient satisfaction survey (PSS) to address the following:  What is the overall level of satisfaction patients have with resident outpatient care?  Can the PSS detect differences in the level of satisfaction patients have with individual residents related to certain competencies?  Does the measurement of patient satisfaction have an effect on resident behaviors and attitudes? Previous studies have suggested that patients of resident physicians are less satisfied than those of attending physicians, especially with regard to the doctor’s personal manner and respect toward the patient. 4,5 Another study showed that patients are generally satisfied with resident care, and that differences in patient satisfaction with the interpersonal and communication skills of individual residents can be identified using a PSS tool. 6 This retrospective study consisted of the analysis of a PSS administered to a family medicine resident continuity clinic population from April through June The four survey subscales were designed to reflect three of the ACGME general competencies: Interpersonal and Communication Skills, Medical Knowledge, and Professionalism The PSS also assessed overall satisfaction with care provided by individual residents. Fig. 1 Competency Subscales by PGY The ABFM, the AAFP, and the STFM are all firmly committed to the concepts of the Personal Medical Home for our patients. Family Medicine residency programs should consider using standardized patient satisfaction surveys as an assessment tool for promoting quality and safety in providing a Personal Medical Home. % who scored 1 or 2 Fig. 2 Impact on Resident Behaviors and Attitudes 1 = worsen a lot 5 = improve a lot % of residents Fig. 3 Value of Patient Satisfaction to Resident Practice Current practice Future private practice 62.5% 75%