Pilot Study for Assessing Nontechnical Skills in Emergency Medicine Residents: Why We Should C.A.R.E

Background: The growing regulatory and hospital focus on patient experience and patient satisfaction is evidenced by the Centers for Medicare and Medicaid Services implementation of Hospital Value-Based Purchasing and by the Accreditation Council for Graduate Medical Education milestones. However, there is a paucity of data examining the education and evaluation of emergency medicine residents' nontechnical skills (eg, communication and situational awareness) as they relate to patient interactions. The purpose of the current study was to evaluate a nontechnical skills rating tool with emergency medicine residents during their interactions with patients. Methods: As part of the educational initiative, the authors consulted with a hospitality training and measurement company, the Freeman Group, that developed and trained faculty on the use of an observational tool to assess physicians' nontechnical skills. Nontechnical skills were assessed in 4 domains designated by the acronym C.A.R.E.: connect with the patient, adjust the interaction to meet patient needs, resolve patient requests, and empathize with the patient. Faculty observed emergency medicine residents as they interacted clinically with patients in the emergency department and rated them on a binary scale: acceptable or unacceptable. Results: Thirty-four of 36 residents were observed. Our study demonstrates that the residents performed very well on domains of empathy, adjusting to patients' knowledge, and resolving requests. However, residents' abilities to customize conversations to patients (eg, addressing patients appropriately and establishing and maintaining rapport) were rated as unacceptable 31% of the time. Conclusion: Overall, residents performed well on most aspects of nontechnical skills observed during their interactions with patients. However, even when residents were mindful of faculty observing nontechnical skills, they performed unacceptably in their communication with patients in approximately one-third of the interactions. This study provides important insight into nontechnical skill areas that may be influenced with intervention to improve patient interactions, and ultimately, influence patient satisfaction.