Measuring patient views of physician communication skills: development and testing of the Communication Assessment Tool.

OBJECTIVE: Interpersonal and communication skills have been identified as a core competency that must be demonstrated by physicians. We developed and tested a tool that can be used by patients to assess the interpersonal and communication skills of physicians-in-training and physicians-in-practice.

METHODS: We began by engaging in a systematic scale development process to obtain a psychometrically sound Communication Assessment Tool (CAT). This process yielded a 15-item instrument that is written at the fourth grade reading level and employs a five-point response scale, with 5=excellent. Fourteen items focus on the physician and one targets the staff. Pilot testing established that the CAT differentiates between physicians who rated high or low on a separate satisfaction scale. We conducted a field test with physicians and patients from a variety of specialties and regions within the US to assess the feasibility of using the CAT in everyday practice.

RESULTS: Thirty-eight physicians and 950 patients (25 patients per physician) participated in the field test. The average patient-reported mean score per physician was 4.68 across all CAT items (S.D.=0.54, range 3.97-4.95). The average proportion of excellent scores was 76.3% (S.D.=11.1, range 45.7-95.1%). Overall scale reliability was high (Cronbach's alpha=0.96); alpha coefficients were uniformly high when reliability was examined per doctor.

CONCLUSION: The CAT is a reliable and valid instrument for measuring patient perceptions of physician performance in the area of interpersonal and communication skills. The field test demonstrated that the CAT can be successfully completed by both physicians and patients across clinical specialties. Reporting the proportion of "excellent" ratings given by patients is more useful than summarizing scores via means, which are highly skewed.

PRACTICE IMPLICATIONS: Specialty boards, residency programs, medical schools, and practice plans may find the CAT valuable for both collecting information and providing feedback about interpersonal and communication skills.