Evaluating CI-CARE Communication Training for Dental Students

Cicely Smith, DDS; Donna Kritz-Silverstein, PhD; Clarice Law, DMD, MS

Section of Pediatric Dentistry, University of California Los Angeles School of Dentistry, Los Angeles, CA

Communication skills are a critical tool for dentists in their interactions with patients during clinical care. Good dentist-patient communication has many potential positive outcomes, including: reduced patient anxiety, increased patient satisfaction, adherence to healthy behaviors, and better oral health outcomes. Although the benefits of effective patient communication skills are well recognized, routine use of communication techniques is low among dentists1. In medicine, efforts have been made to improve communication skills among providers, with positive results. A highly successful best practice model is CI-CARE, UCLA Health Systems provider-to-patient method of communication, which includes a standard script of 6 communication behaviors. As a quality improvement initiative, CI-CARE has been correlated with significant increases in medical patient satisfaction2. Although the School of Dentistry clinics are part of UCLA Health System, CI-CARE has not yet been integrated into the care of dental patients. No studies have assessed the CI-CARE model in dentistry. Purpose: To evaluate the effects of CI-CARE training on patient satisfaction with dental students communication behavior.

C Connect with pa-ents by addressing them as Mr./Ms. or by the name that they prefer I Introduce yourself and your role C Communicate what you are going to do, how long it is going to take, and how it will impact the pa-ent A Ask and an-cipate pa-ent needs, ques-ons or concerns R Respond to pa-ent ques-ons or requests with immediacy E Exit courteously and/or with an explana-on of what will come next Figure 1: CI-CARE provider-to-patient communication model

TABLE 2: PATIENT ASSESSMENT OF DENTAL STUDENT COMMUNICATION PERFORMANCE BY CI-CARE TRAINING STATUS Untrained Trained t Mean Mean My student dentist listens to my questions and concerns. 4.9 4.8 +1.49 My student dentist does his/her utmost to ensure that I get the best care. My student dentist communicates well with me. My student dentist is respectful and considerate. 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 4.9 -0.11 -0.72 +0.31 -0.39 -0.42 -0.12

p .07 .46 .24 .38 .35 .34 .45

My student dentist is sensitive to my physical and 4.9 emotional needs. My student dentist uses language that I can understand. 4.9 My student dentist educates me about my dental condition and care. 4.9

Patients were asked to what extent they agreed or disagreed with the above statements. Likert Scale 1 = Strongly disagree 2 = Disagree 3 = Neither agree nor disagree 4 = Agree 5 = Strongly agree

There were no significant differences between patients of trained and untrained students in age, gender, educational level, appointment type, mean number of previous appointments, and gender of student dentist. Almost all patients, regardless of the training status of their student, reported that their student engaged in all 6 elements of the CI-CARE patient communication script during their encounter.
TABLE 1: PATIENT RATING OF DENTAL STUDENT COMMUNICATION BEHAVIOR BY CI-CARE TRAINING STATUS Untrained Trained t Mean Mean Being friendly when greeting you in the reception area? 4.9 4.8 +0.71 Making regular eye contact? Having a pleasant tone of voice? 4.8 4.8 4.8 4.9 4.9 4.8 4.9 4.8 4.8 4.8 4.8 4.7 -0.10 -0.67 +0.16 +0.48 -0.35 +1.20 +0.39 +0.30 -0.11 +0.76

This study provides the first pilot test of CI-CARE within dentistry. Overall, patients perceived their student dentists as having strong performance in communication behaviors, including: initial greetings, relationship-building, non-verbal communication, sharing information, attention to comfort, and team communication. There were no significant differences in patient satisfaction with communication behavior between patients of 3rd year dental students who did and did not receive CI-CARE training. However, the patient encounter tested in this study was a 3 hour dental school appointment which is not representative of most dentist-patient encounters. In addition, most patients were established patients. Future studies could investigate the application of CI-CARE training to dental appointments of shorter duration or to first time encounters.

p .24 .46 .25 .44 .32 .36 .12 .35 .38 .46 .22

Study Design: Half of the UCLA year pre-doctoral class (50 students) received training in CI-CARE (Figure 1). The other half served as a control, receiving no training. Study Procedures: A 24-item survey was administered to adult patients of 3rd year students at the end of dental appointments in the UCLA general clinic to assess the patients perceptions of their encounters with the students and the students communication behavior. The survey incorporates items from the Assessing Residents CI-CARE Program survey2 and the Patient Communication Assessment Instrument3,4. Study Population: 99 surveys were collected from adult patients of 67 3rd year dental students. 51 surveys came from patients of students trained in CI-CARE and 48 came from patients of untrained students. Data Analysis: Comparisons were performed with chi square analysis and independent t-tests using VassarStats and Excel.

3rd

Helping you to relax and be as comfortable as possible? 4.9 Asking you to signal him/her if you were in pain? Being encouraging and reassuring during treatment? Talking with you during the procedure? Treating you as an individual with unique needs and concerns (not a mouth)? Making sure that you understood any information that was being provided? Making sure instructors were introduced to you? 4.8 4.9 4.9 4.9 4.8 4.8

Letting you know how long she/he might be away if she/ 4.8 he left the cubicle?

Patients were asked to rate their dental student regarding the above behaviors during the appointment they had that day. Likert Scale 1 = Poor 2 = Fair 3 = Good 4 = Very good 5 = Excellent

1. Rozier RG, Horowitz AM, Podschun G. Dentist-patient communication techniques used in the United States: the results of a national survey. JADA 2011;142:518-530. 2. Wen T, Huang B, Mosley V, Afsar-Manesh N. Promoting patient-centred care through trainee feedback: assessing residents' C-I-CARE (ARC) program. BMJ Qual Saf 2012;21(3):225-33. 3. Schnwetter, DJ, Wener ME, Mazurat N. Determining the validity and reliability of clinical communication assessment tools for dental patients and students. J Dent Educ 2012;76(12):1276-1290. 4. Wener ME, Schnwetter DJ, Mazurat N. Developing new dental communication skills assessment tools by including patients and other stakeholders. J Dent Educ 2011;75(12):1527-41.