Observing pediatric residents' communication skills during sick visits: Do they determine caregivers' main concern and their reasons for concern, and are caregivers satisfied?

Larrie greenberg


Fifty years ago, Dr. Barbara Korsch published her seminal work on pediatric resident communication skills, demonstrating that residents did not always ascertain the caregivers’ main concern for the visit was and specifically, why those caregivers were concerned.  

Repeating her study using a direct observation methodology, the authors evaluated 103 pediatric sick visits at a large children’s hospital primary care clinic to determine 1) if residents elicited the caregiver’s main concern about their child’s acute illness, 2) why they were concerned, and 3) whether asking these questions was statistically associated with caregiver satisfaction, which was determined by an exit survey.

Results of the study revealed that residents determined the caregivers’ main concern in 84.5% of visits. However, residents established why the caregiver was concerned in only 38.6% of visits. Caregiver satisfaction with the visits was high, with 90.3% rating it “one of the best” or “very good.” Higher satisfaction was associated with the resident asking why the caregiver was concerned (z = 2.76, p = .006).

We conclude that pediatric residents often ask caregivers about their main concern, but less frequently elicit why caregivers are concerned. Not understanding caregivers’ reasons for concerns about their children, biologically based or not, may be related to unnecessary ongoing anxiety about the illness as noted in Korsch’s studies.  Probing the root of caregiver concern may be important for their satisfaction and should highlight this important aspect of communication to those responsible for medical student and pediatric resident communication skills training. ?

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