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PubMed1983

Awareness during anaesthesia: a review.

Following the introduction of muscle relaxants into anaesthesia there became recognised a state in which patients may be aware of their surroundings but unable to communicate their plight. This state of awareness is more likely to occur during light inhalational or total intravenous anaesthesia. Detection of awareness is difficult and several methods have been described. Measurement of the depth of anaesthesia is also difficult as clinical signs are unreliable and even sophisticated monitoring equipment is unhelpful. Awareness can occur without patient recall and may be due to equipment failure or anaesthetic failure. The former is avoidable and the latter ought to be. Recommendations have been made regarding the use of premedicant drugs and volatile anaesthetic agents to reduce the incidence of awareness.

Anesthesia, General↗
PubMed1993

The results of tubal surgery in the treatment of infertility in Wellington 1986-90.

AIMS: To audit the outcome of tubal surgery performed in Wellington between 1986-90. To establish the appropriate indications for tubal surgery in terms of likely benefit. To compare benefit with other treatment modalities namely in vitro fertilisation. METHODS: Data obtained from hospital patient notes, theatre records and personal communication. RESULTS: There were 71 patients, 67 of whom had been adequately followed up. The total pregnancy rate was 41.8% with an overall term pregnancy rate of 29.8%. The success rate was highest with proximal tubal occlusion and worst for distal disease and endometriosis. CONCLUSION: The outcome of the audit is consistent with results worldwide. Tubal surgery allows for natural conception and more than one pregnancy can be conceived as a result. It should be considered the first line treatment for proximal tubal disease and fimbrial adhesions. In vitro fertilisation however should be offered to those with severe distal disease and severe endometriosis.

Constriction, Pathologic↗
PubMed2001

Meeting the needs of future physicians: a core curriculum initiative for postgraduate medical education at a Canadian university.

UNLABELLED: In addition to possessing medical expertise, contemporary physicians are expected to be skilled communicators, critical consumers and users of medical research, teachers, collaborators, health care advocates, and managers. A core curriculum is a common set of learning experiences designed to help prepare physicians for these complex roles. PURPOSE: This article describes the design and implementation of one core curriculum, summarizes the feedback received from residents, and shares some of the lessons we are learning as we use feedback to develop our programme. METHOD: The core curriculum described was implemented at a Canadian university which offers 56 residency programmes with a total enrollment of approximately 360 students. The curriculum consisted of 30 sessions organized around four themes: biostatistics and epidemiology; communications and teaching skills; healthcare management, and ethical, medicolegal and lifestyle issues. Each session in the Core Curriculum was evaluated by residents with respect to the timing, quality, and value of the learning experience. In addition, residents participated in focus group discussions of their Core Curriculum experiences. RESULTS: Key findings related to the characteristics of effective core curriculum learning experiences and to the barriers to implementing a core curriculum across programmes. Of particular salience were findings related to explicit issues of attendance and the diverse needs of learners and programmes, and to more implicit issues of communication and managing change. The specific content and format of the Core Curriculum and the results of the evaluation process will be of interest to others considering a core curriculum for postgraduate medical programmes.

Clinical Competence↗
PubMed2004

Achieving involvement: process outcomes from a cluster randomized trial of shared decision making skill development and use of risk communication aids in general practice.

BACKGROUND: A consulting method known as 'shared decision making' (SDM) has been described and operationalized in terms of several 'competences'. One of these competences concerns the discussion of the risks and benefits of treatment or care options-'risk communication'. Few data exist on clinicians' ability to acquire skills and implement the competences of SDM or risk communication in consultations with patients. OBJECTIVE: The aims of this study were to evaluate the effects of skill development workshops for SDM and the use of risk communication aids on the process of consultations. METHODS: A cluster randomized trial with crossover was carried out with the participation of 20 recently qualified GPs in urban and rural general practices in Gwent, South Wales. A total of 747 patients with known atrial fibrillation, prostatism, menorrhagia or menopausal symptoms were invited to a consultation to review their condition or treatments. Half the consultations were randomly selected for audio-taping, of which 352 patients attended and were audio-taped successfully. After baseline, participating doctors were randomized to receive training in (i) SDM skills or (ii) the use of simple risk communication aids, using simulated patients. The alternative training was then provided for the final study phase. Patients were allocated randomly to a consultation during baseline or intervention 1 (SDM or risk communication aids) or intervention 2 phases. A randomly selected half of the consultations were audio-taped from each phase. Raters (independent, trained and blinded to study phase) assessed the audio-tapes using a validated scale to assess levels of patient involvement (OPTION: observing patient involvement), and to analyse the nature of risk information discussed. Clinicians completed questionnaires after each consultation, assessing perceived clinician-patient agreement and level of patient involvement in decisions. Multilevel modelling was carried out with the OPTION score as the dependent variable, and rater, consultation and clinician levels of data, standardized by rater within clinician. RESULTS: Following each of the interventions, the clinicians significantly increased their involvement of patients in decision making (OPTION score increased by 10.6 following risk communication training [95% confidence interval (CI) 7.9 -13.3; P < 0.001] and by 12.9 after SDM skill development (95% CI 10 -15.8, P < 0.001), a moderate effect size. The level of involvement achieved by the risk communication aids was significantly increased by the subsequent introduction of the skill development workshops (7.7 increase in OPTION score, 95% CI 3.4-12; P < 0.001). The alternative sequence (skills followed by risk communication aids) did not achieve this effect. The use of most risk information formats increased after the provision of specific risk communication aids (P < 0.001). Clinicians using the risk communication tools perceived significantly higher patient and clinician agreement on treatment (P < 0.001), patient satisfaction with information (P < 0.01), clinician satisfaction with decision (P < 0.01) and general overall satisfaction with the consultation (P < 0.001) than those who were exposed to SDM skill development workshops. CONCLUSIONS: These clinicians were able to acquire the skills to implement SDM competences and to use risk communication aids. Each intervention provided independent effects. Further progress towards greater patient involvement in health care decision making is possible, and skill development in this area should be incorporated into postgraduate professional development programmes.

Adult↗
PubMed2005

Evaluation of the parents as primary sexuality educators program.

PURPOSE: To determine the effectiveness of a sexuality education program designed to help parents become more confident and competent in communicating with their children about sex and sexuality. METHODS: Parents attending a four- to five-part workshop series between February 2001 and April 2002 were recruited to participate. A total of 27 workshop series were conducted at various sites in neighborhoods with high teen pregnancy and STD rates. For each series, program staff administered written pre- and post-workshop surveys to parents and parent surrogates. A follow-up telephone survey was conducted with participants 10 weeks after the last workshop. Matched pre-workshop and follow-up surveys were obtained from 174 participants. RESULTS: Comparison of follow-up to pre-workshop responses revealed that more participants thought discussing sexuality with their children was very important (83% vs. 75%; p < .01). More participants also reported that they often initiate conversations with their children on a variety of topics including sex/intercourse, human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS), pregnancy, sexuality and gender issues, and their personal standards for sexual behavior. Participants also became more comfortable discussing sensitive topics with their children. At follow-up, more participants responded that they were very comfortable answering their children's questions on the above topics. (All p values < .01.) CONCLUSIONS: The Parents as Primary Sexuality Educators program may be an effective way to increase parent-child communication about health, sexuality, and values. Enhancing parents' ability to communicate expectations and values about sexuality may help support children in making healthy decisions about sexual behavior as adolescents.

Adolescent↗
PubMed2003

Differences in the perception of blood transfusion risk between laypeople and physicians.

BACKGROUND: There is little objective evidence to support the commonly held belief that laypeople perceive blood transfusion risk differently from physicians. Acknowledging and characterizing such differences may improve risk communication. The objective of this study was to characterize how laypeople and physicians perceive the risks of blood transfusion in comparison with a wide variety of other hazards. STUDY DESIGN AND METHODS: A total of 161 laypeople and 91 physicians and medical trainees were surveyed in Kingston, Ontario, between March and August 2000. The perceived riskiness and other qualitative characteristics of blood transfusion and 9 other hazards were measured by psychometric scaling and principal components analysis. RESULTS: The overall return rate was 100 percent, with 86 percent of surveys having no missing responses. Physicians perceived the risks of blood transfusion and most other hazards to be less dreaded and severe, but also less understood and controllable than laypeople. CONCLUSION: Laypeople and physicians perceive risk differently for blood transfusion, but this perceptual gap between the groups for blood transfusion may be representative of a more generalized phenomenon that spans different types of hazards, both medical and nonmedical. Awareness of such differences may facilitate risk communication and shared decision making between physicians and their patients.

Adult↗
PubMed1994

Quality of care in general practice. A delphi study of indicators and methods.

OBJECTIVE: To identify methods for measuring quality of care in general practice, and to assess general practitioners' views about their acceptability, practicality and usefulness. DESIGN: A delphi design was used. Questionnaires consisting mainly of open-ended questions were sent to 50 general practice teachers in New South Wales. A second questionnaire derived from the responses from the first round was sent to the same GPs who were asked to rate each of the responses. RESULTS: The response rate by the general practitioners was 46 per cent for the first questionnaire and 64 per cent for the second one. A total of 29 indicators of quality of care and 20 strategies for assessing quality were suggested. The most favoured indicators were appropriate prescribing, communication skills, and participation in continuing medical education. A mixture of methods assessing both performance and competence was suggested. CONCLUSION: A good consensus was achieved by teaching general practitioners criteria for defining and measuring quality of care.

Delphi Technique↗
PubMed2004

Interaction of genetic risk and adoptive parent communication deviance: longitudinal prediction of adoptee psychiatric disorders.

BACKGROUND: In the Finnish Adoptive Family Study of Schizophrenia, adoptee thinking disorders have been shown to be a joint effect of genetic liability for schizophrenia spectrum disorders and adoptive rearing-parent communication patterns. However, longitudinal predictions of clinical psychiatric disorders of the adoptees have not been reported. METHOD: Adoptees (n = 109) who had no DSM-III-R disorder at initial assessment (median age 18 years) were selected from the total sample of the Finnish Adoption Study of Schizophrenia. They were defined as at high versus low genetic risk based upon the lifetime diagnoses of their biological, adopting-away mothers - schizophrenia spectrum disorder versus no spectrum disorder. At initial assessment, adoptive rearing parents were independently evaluated from tape-recorded Rorschach protocols scored as manifesting either high or low Communication Deviance (CD), a composite index of communication patterns that distract and befuddle listeners. Adoptees were independently re-diagnosed after a median interval of 14 years and followed-up from national registers for an additional 7 years. RESULTS: The main effects of genetic liability (G) and CD of the adoptive parents (E), each taken separately, predicted significantly for psychiatric disorders of the adoptees as adults. However, when G, E, and their joint interaction effect were entered into the same logistic model, only the interaction effect was significant. The sample included seven adoptees with schizophrenia spectrum disorders, but a separate analysis to predict them was non-significant. CONCLUSION: Genetic liability for schizophrenia spectrum disorder and an adoptive family rearing variable interact, predicting longitudinally and significantly to broadly defined adoptee psychiatric disorder.

Adoption↗
PubMed2003

A brain-computer interface (BCI) for the locked-in: comparison of different EEG classifications for the thought translation device.

OBJECTIVE: The Thought Translation Device (TTD) for brain-computer interaction was developed to enable totally paralyzed patients to communicate. Patients learn to regulate slow cortical potentials (SCPs) voluntarily with feedback training to select letters. This study reports the comparison of different methods of electroencephalographic (EEG) analysis to improve spelling accuracy with the TTD on a data set of 6,650 trials of a severely paralyzed patient. METHODS: Selections of letters occurred by exceeding a certain SCP amplitude threshold. To enhance the patient's control of an additional event-related cortical potential, a filter with two filter characteristics ('mixed filter') was developed and applied on-line. To improve performance off-line the criterion for threshold-related decisions was varied. Different types of discriminant analysis were applied to the EEG data set as well as on wavelet transformed EEG data. RESULTS: The mixed filter condition increased the patients' performance on-line compared to the SCP filter alone. A threshold, based on the ratio between required selections and rejections, resulted in a further improvement off-line. Discriminant analysis of both time-series SCP data and wavelet transformed data increased the patient's correct response rate off-line. CONCLUSIONS: It is possible to communicate with event-related potentials using the mixed filter feedback method. As wavelet transformed data cannot be fed back on-line before the end of a trial, they are applicable only if immediate feedback is not necessary for a brain-computer interface (BCI). For future BCIs, wavelet transformed data should serve for BCIs without immediate feedback. A stepwise wavelet transformation would even allow immediate feedback.

Communication Devices for People with Disabilities↗
PubMed2005

Smoking and elevated blood pressure are the most important risk factors for subarachnoid hemorrhage in the Asia-Pacific region: an overview of 26 cohorts involving 306,620 participants.

BACKGROUND AND PURPOSE: The cause of subarachnoid hemorrhage (SAH) is poorly understood and there are few large cohort studies of risk factors for SAH. We investigated the risk of SAH mortality and morbidity associated with common cardiovascular risk factors in the Asia-Pacific region and examined whether the strengths of these associations were different in Asian and Australasian (predominantly white) populations. METHODS: Cohort studies were identified from Internet electronic databases, searches of proceedings of meetings, and personal communication. Hazard ratios (HRs) for systolic blood pressure (SBP), current smoking, total serum cholesterol, body mass index (BMI), and alcohol drinking were calculated from Cox models that were stratified by sex and cohort and adjusted for age at risk. RESULTS: Individual participant data from 26 prospective cohort studies (total number of participants 306,620) that reported incident cases of SAH (fatal and/or nonfatal) were available for analysis. During the median follow-up period of 8.2 years, a total of 236 incident cases of SAH were observed. Current smoking (HR, 2.4; 95% CI, 1.8 to 3.4) and SBP >140 mm Hg (HR, 2.0; 95% CI, 1.5 to 2.7) were significant and independent risk factors for SAH. Attributable risks of SAH associated with current smoking and elevated SBP (> or =140 mm Hg) were 29% and 19%, respectively. There were no significant associations between the risk of SAH and cholesterol, BMI, or drinking alcohol. The strength of the associations of the common cardiovascular risk factors with the risk of SAH did not differ much between Asian and Australasian regions. CONCLUSIONS: Cigarette smoking and SBP are the most important risk factors for SAH in the Asia-Pacific region.

Adult↗
PubMed1995

Advances in the diagnosis and treatment of neonatal hyperbilirubinemia.

Many controversies remain regarding the role of bilirubin in the developing human. Although kernicterus and cognitive impairment have been linked to hyperbilirubinemia, more recent studies have suggested that there might actually be beneficial effects of bilirubin at a cellular level; thus, the need to better understand the molecular and cellular physiology of this molecule is important. The attempted management of serum or tissue levels of bilirubin may either have implications for long-term neurologic development or interfere with normal body stress responses. Production of CO via heme catabolism also warrants further investigation regarding its role in cell to cell communication or in other important cellular reactions. New methods are being developed to better detect CO under a variety of experimental conditions, as well as to estimate total bilirubin production by measuring the COHb level of pulmonary excretion of CO. The development of new drugs to modulate bilirubin production is the subject of ongoing research. Although some metalloporphyrins already have been used clinically, the advantages and disadvantages of each drug still require further study. These new drugs are not only raising fascinating research questions about heme and bilirubin metabolism, but they may soon revolutionize the way we approach the diagnosis and management of neonatal jaundice, and provide new pharmacologic tools for exploring other aspects of metabolism.

Humans↗
PubMed2005

How surgeons disclose medical errors to patients: a study using standardized patients.

BACKGROUND: Calls are increasing for physicians to disclose harmful medical errors to patients, but little is known about how physicians perform this challenging task. For surgeons, communication about errors is particularly important since surgical errors can have devastating consequences. Our objective was to explore how surgeons disclose medical errors using standardized patients. METHODS: Thirty academic surgeons participated in the study. Each surgeon discussed 2 of 3 error scenarios (wrong-side lumpectomy, retained surgical sponge, and hyperkalemia-induced arrhythmia) with standardized patients, yielding a total of 60 encounters. Each encounter was scored by using a scale developed to rate 5 communication elements of effective error disclosure. Half of the encounters took place face-to-face; the remainder occurred by videoconference. RESULTS: Surgeons were rated highest on their ability to explain the medical facts about the error (mean scores for the 3 scenarios ranged from 3.93 to 4.20; maximum possible score, 5). Surgeons used the word error or mistake in only 57% of disclosure conversations, took responsibility for the error in 65% of encounters, and offered a verbal apology in 47%. Surgeons acknowledged or validated patients' emotions in 55% of scenarios. Eight percent discussed how similar errors would be prevented, and 20% offered a second opinion or transfer of care to another surgeon. CONCLUSIONS: The patient safety movement calls for disclosure of medical errors, but significant gaps exist between how surgeons disclose errors and patient preferences. Programs should be developed to teach surgeons how to communicate more effectively with patients about errors.

Communication↗
PubMed1983

Fast count-dependent digital filtering of nuclear medicine images: concise communication.

The formulation of an "optimal" filter for improving the quality of digitally recorded nuclear medicine images is reported in this paper. The method forms a Metz filter for each image based upon the total number of counts in the image, which in turn determines the average noise level. The parameters of the filter were optimized for a set of simulated images using the minimization of the mean-square error as the criterion. The speed of the image formation results from the use of an array processor. In a study of localization receiver operating characteristics (LROC) using the Alderson liver phantom, a significant improvement in tumor localization was found in images filtered with this technique, compared with the original digital images and those filtered by the nine-point binomial smoothing algorithm. The technique has been found useful for the filtering of static and dynamic studies as well as the two-dimensional pre-reconstruction filtering of images from single photon emission computerized tomography.

Computers↗
PubMed2005

Biochemical analysis of pancreatic fluid collections predicts bacterial infection.

BACKGROUND AND AIMS: Despite our understanding of the pathophysiology of different types of pancreatic fluid collections (PFC), few studies have attempted to correlate the biochemical analysis of PFC contents with clinical and radiological characteristics. The aim of this study was to assess the predictive value of fluid analysis for discerning collection type (pseudocyst vs acute fluid collection with necrosis), presence of infection or communication with the pancreatic duct in the setting of acute and chronic pancreatitis. METHODS: Pancreatic fluid from 34 consecutive patients undergoing endotherapy of PFC was prospectively analyzed for seven variables: lactate dehydrogenase (LDH), total protein, albumin, glucose, amylase, lipase and specific gravity. RESULTS: In multivariate analysis, adjusting for age and gender, high intracystic levels of protein (OR 6.2; 95% CI 1.3-37.0), LDH (OR 6.8 [2.3-38.3]), and albumin (OR 7.8 [1.3-67.4]), and low levels of glucose (OR 0.2 [0.03-0.9]) predicted the presence of PFC infection. The optimal threshold value for protein was 1000 g/dL, which achieved a sensitivity of 73% and specificity of 75% for detecting infection; the optimal cut-off for LDH was 1000 U/L (sensitivity 64%, specificity 85%), and the cut-off for albumin was 500 g/dL (sensitivity 75%, specificity 85%). There were no statistically significant differences in biochemical fluid analysis with respect to fluid collection type (pseudocysts vs acute fluid collection with necrosis) and the presence of pancreatic duct communication. CONCLUSIONS: Biochemical analysis of PFC fluid is clinically helpful in detecting fluid infection in patients with bacteria on Gram stain or positive fluid cultures. Our findings fail to support the utility of fluid analysis in characterizing cyst type, and we caution against its use in distinguishing pseudocysts from acute fluid collection with necrosis.

Acute Disease↗
PubMed2006

[Use of actors to train medical students in communication skills].

BACKGROUND: The aim of our study was to investigate how medical students perceive the use of actors in the communication and consultation training at the University of Bergen, Norway. MATERIAL AND METHODS: A questionnaire was distributed to third year medical students attending the communication course the autumn 2004 and sixth year students attending the consultation course spring 2005. The students were asked to respond to statements related to how they had benefited from training with an actor. Further, they were asked to describe advantages and disadvantages with this teaching method. Quantitative data were presented descriptively as percentages. Qualitative data were analysed with a phenomenological method, as described by Giorgi and modified by Malterud. A total of 188 out of 215 students (87 %) answered the questionnaire. RESULTS: Nearly all students (97 %) expressed that the teaching sessions with an actor had been valuable. The role-plays were described as credible and realistic. However, the students pointed at the risk of exaggerating the patient roles and lack of nuancing. Many students expressed the benefit of observing and practicing communication skills in role-plays based on theoretical models that had been taught in the lectures. Teaching with an actor was regarded as entertaining, engaging and beneficial. INTERPRETATION: The students expressed that the use of an actor in the communication and consultation training was beneficial. However, it remains to investigate whether this teaching method contributes to educating doctors with improved communication skills.

Clinical Competence↗
PubMed2001

Feasibility of transcatheter closure of multiple defects within the oval fossa.

BACKGROUND: Multiple perforations in the floor of the oval fossa may be an obstacle for transcatheter closure. Thus, we analyzed the interventions in 33 patients with more than one interatrial communication in comparison with 370 procedures with a single defect. METHODS AND RESULTS: A diagnostic catheterization, which included a balloon-sizing maneuver, was performed. We implanted a total of 46 occluders, made up of 42 Amplatzers and 4 CardioSEALs. In 20 patients, the defects were closed with a single occluder, namely 18 Amplatzer and 2 CardioSEAL devices. Complete closure was achieved in 15 patients, while a tiny residual shunt remained in 5 patients. In 13 patients, two devices were implanted, without any residual shunt being found immediately after implantation. In 3 patients, the occluders did not touch each other. In 10 patients, their rims overlapped. In comparison with the control group, the group with multiple defects did not differ in the distribution of age, gender, and indications for device closure. The mean time of the procedure, and the time required for fluoroscopy, however, were significant longer (P<0.001). These times ranged from 45 to 250 minutes with a median of 140 minutes, and from 0.0 to 39.2 minutes, with a median of 12.0 minutes, respectively. Also, the association with an atrial septal aneurysm was significantly more frequent (61 vs. 17%; P<0.001). The times taken during insertion of double devices were also significantly longer than those needed for insertion of a single device (P<0.001). CONCLUSIONS: Transcatheter closure of multiple defects within the oval fossa is feasible with currently available occluders, albeit than, in selected cases it is necessary to implant two devices.

Adolescent↗
PubMedDate not supplied

[Child in dentistry: person or puppet?].

Many years ago the author introduced and advocated the comprehensive approach in pediatric dentistry. He emphasized the priority of an empatic relationship among child, mother and dentist with positive communication channels. The use of sedation, other aversive methods and even an hypertechnical attitude are only attempts to avoid the child's anxiety. Wi need him as a total person, not as a typodont.

Anesthesia, Dental↗
PubMedDate not supplied

Missed opportunities: a descriptive assessment of teaching and attitudes regarding communication skills in a surgical residency.

BACKGROUND: The Accreditation Council for Graduate Medical Education (ACGME) requires that "residents must be able to demonstrate interpersonal and communication skills that result in effective information exchange and teaming with patients, their patients' families, and professional associates." The authors sought to assess current methods of teaching and attitudes regarding communication skills in their surgical residency. METHODS: After obtaining Institutional Review Board (IRB) exemption, voluntary anonymous surveys were completed by a sample of convenience at the Vanderbilt University Medical Center: surgical residents at Grand Rounds and attending surgeons in a faculty meeting. Data were evaluated from 49 respondents (33 of 75 total surgical residents, 16 representative attending surgeons). RESULTS: One hundred percent of respondents rated the importance of communication to the successful care of patients as "4" or "5" of 5. Direct attending observation of residents communicating with patients/families was confirmed by residents and faculty. Residents reported varying levels of comfort with different types of conversations. Residents were "comfortable" or "very comfortable" as follows: obtaining informed consent, 91%; reporting operative findings, 64%; delivering bad news, 61%; conducting a family conference, 40%; discussing do not resuscitate (DNR) orders, 36%; and discussing transition to comfort care, 24%. Resident receptiveness to communication skills education varied with proposed venues: 84% favored teaching in the course of routine clinical care, 52% via online resources, and 46% in workshops. Residents were asked how frequently they received feedback specific to their communication skills during the past 6 months: Most residents reported 0 (39%) or 1 (21%) feedback episode. Only 30% of resident respondents reported receiving feedback that they perceived helpful. Attending surgeons reported that they did provide residents feedback specific to their communication skills. When asked to estimate the number of feedback episodes in the last 6 months, 16 faculty members reported a total of 67 feedback episodes, whereas 33 residents reported a total of only 24 episodes. Most faculty members rated their comfort with providing feedback specific to communication skills as "very comfortable" (56%) or "comfortable" (19%). "Time constraints" was the most frequently cited barrier to teaching communication skills. CONCLUSIONS: Communication skills are valued as integral to patient care by both residents and faculty in this study. Residents are most receptive to teaching of communication skills in the clinical setting. Faculty members report they are providing feedback to residents. Although residents report direct observation by faculty, currently only a minority (30%) are receiving feedback regarding communication that they consider helpful. A need exists to facilitate the feedback process to resolve this discrepancy. The authors propose that an evaluation instrument regarding communication skills may strengthen the feedback process.

Attitude of Health Personnel↗