The effect of medical education on students' patient-satisfaction ratings

To determine whether medical students' interpersonal and communication skills, as measured by satisfaction ratings given by standardized patients (SPs), improves or deteriorates with additional training and experience.

A longitudinal study was made of a single cohort of 133 medical students scheduled to graduate in 1994 from the University of Illinois College of Medicine at Chicago. Clinical performance examinations employing clinical encounters with SPs were given at the end of the students' second year at the end of the first quarter of their fourth year. The second-year examination consisted of four student-SP encounters for each student; the fourth-year examination consisted of 16 such encounters. For each examination, SP perceptions of interpersonal and communication skills were measured using six items from the American Board of Internal Medicine Patient Satisfaction Questionnaire; the items employed five ordinal-scale descriptors (from 1 = poor to 5 = excellent). The unit of analysis was the student-SP encounter. For each year, ratings on each item were averaged across encounters to produce a mean rating for each item; in addition, ratings across all the encounters and items were averaged to produce a mean total patient satisfaction rating. The percentage of fail or poor ratings given for each item was calculated, as was the average of these percentages across the items. All rating calculations were done between years and between genders. Two-tailed, paired t-tests and F-ratios were used for comparisons between years and between genders, respectively. Finally, ratings for a comparison group of first-, second-, and third-year internal medicine residents were gathered under similar testing conditions.

Mean total patient satisfaction with the students' clinical performances improved from the first examination (3.51, SD, .84) to the second (3.60, SD, .86). The percentage of student encounters receiving fair or poor ratings decreased from 14.5% in the second year to 12% in the fourth year; resident encounters received a fair or poor rating 7.8% of the time. The female students received fewer fair or poor ratings than did the male students both in their second year (11.7% vs 16%) and in their fourth year (9.3% vs 12.8%). Of the six patient-satisfaction items, both the students and the residents consistently were ranked lowest in encouraging patients to ask questions and answering patient questions.

Contrary to the stated beliefs of some physician-educators that students' skills deteriorate during the course of training, these medical students' interpersonal and communication skills improved with additional training and experience.