BASIC/CLINICAL SCIENCE
Perceptions, Attitudes, and Satisfaction Concerning Resident Participation in Health Care among Dermatology Outpatients Khalid M. AlGhamdi, Hind M. AlMohanna, Salim S. AlKeraye, Fahad M. AlSaif, and Saleh K. AlRasheed
Background: A limited number of published studies have discussed patient attitudes toward resident physicians' participation in dermatology clinics. A literature search failed to identify any such study in the Middle East. Objective: The aim of this study was to explore patient perceptions and attitudes toward resident participation in dernnatology outpatient clinics. Methods: A self-administered questionnaire focused on patient attitudes toward dermatology resident participation was distributed randomly to all adult outpatients attending dermatology clinics at a university hospital in Saudi Arabia between July and September 2010. Results: The questionnaire was returned by 742 of 900 patients, for an 82% response rate. The mean patient age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The major reason for visiting the hospital was a medical dermatology consultation (80.4%). Only 35% of the patients self-reported an accurate understanding of the "resident" designation. In total, 86.4% of patients were satisfied with the residents' behavior. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the residents. The patients agreed with resident participation in their health care. The majority of the patients expressed their willingness to provide a medical history and receive counseling from residents (87.6% and 86.3%, respectively). There was no gender-associated effect on the understanding of the resident position or the decision to receive a physical examination by a resident. Conclusion: Dermatology outpatients are satisfied and have positive perceptions and attitudes toward resident participation in the dermatology clinic. Contexte: Peu d'études publiées portent sur les attitudes des patients à l'égard de la participation des résidents en dermatologie, et un examen de la documentation n'a pas permis de relever d'étude en la matière, au Moyen-Orient. Objectif: L'étude visait à examiner les perceptions et les attitudes des patients à l'égard de la participation des résidents en dermatologie externe. Méthode: Un questionnaire à remplir soi-même, portant sur les attitudes des patients à l'égard de la participation des résidents en dermatologie a été remis au hasard à tous les adultes externes qui sont allés consulter en dermatologie, dans un hôpital universitaire, en Arabie Saoudite, de juillet à septembre 2010. Résultats: Au total, 742 patients sur 900 ont rempli le questionnaire, ce qui a porté à 82% le taux de réponse. L'âge moyen était de 30.58 ± 11.67 ans, et 42% (311 sur 742) des répondants étaient des hommes. Le principal motif de visite à l'hôpital était une consultation médicale en dermatologie (80.4%). Seuls 35% des patients ont indiqué avoir une bonne compréhension du titre de résident. En tout, 86.4% des répondants se sont dits contents du comportement des résidents. Qui plus est, 98.4% des patients étaient satisfaits des soins médicaux donnés par les résidents. Les patients étaient d'accord sur la participation des résidents à la prestation des soins de santé. La plupart des patients se sont montrés disposés à fournir des renseignements sur leurs antécédents médicaux aux résidents et à recevoir des conseils d'eux (87.6% et 86.3%, respectivement). Aucun effet lié au sexe quant à la compréhension du rôle de résident ou à la décision de subir un examen physique par un résident n'a été relevé.
From the Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Address reprint requests to: Khalid M. AlGhamdi, MD, Dermatology Department, College of Medicine, King Saud University, PO Box 240997, Riyadh 11322, Saudi Arabia; e-mail: kmgderm@yahoo,com.
^ O I 10.2310/7750.2013.13010 © 2014 Canadian Dermatology Association
DECKEI^ ' 20
Canadian Dermatology Association I Journal of Cutaneous Medicine and Surgery, Vol IS, No 1 (January/February), 2014: pp 20-27
Outpatient Perceptions, Attitudes, and Satisfaction Concerning Resident Participation
Conclusions: Les malades externes en dermatologie sont satisfaits de la participation des résidents en dermatologie et ont des perceptions et des attitudes favorables à l'égard de leur rôle.
ESIDENCY TRAINING PROGRAMS necessitate resident participation in dermatology clinics. As a resuit, residents gain knowledge and practice experience and improve their clinical skills. Patients' attitudes toward residents are variable, and several factors play a role in determining patient perceptions.' An assessment of health care quality through satisfaction measurements is essential.^'^ Earlier studies have shown high patient satisfaction levels in other medical disciplines.' Few studies discuss patient attitudes toward resident participation in outpatient clinics.''*""' In general, patients are satisfied when being treated by residents in dermatology and community teaching clinics.'''' Respondents recognize the importance of training new physicians, although they prefer being seen by the same doctor repeatedly.* In terms of clinical skills, the majority of patients agree that the residents' skills were equivalent to those of the ordinary physician.* Moreover, the patients perceived advantages to being treated by a resident. For instance, residents provided longer consultation times and shorter waiting times.* However, it is often assumed that the attitudes of patients toward residents in their health care might be negative. To the best of our knowledge, this is the first study discussing the impact of residents' contribution to the care of patients attending dermatology clinics in the Middle East. It is the second study performed worldwide; the first study was conducted in the United States.' The aim of this study was to evaluate dermatology outpatients' perceptions, attitudes, and satisfaction regarding resident participation in their care.
and required approximately 8 minutes to complete (Appendix). This study was approved by the local ethics committee. A self-administered questionnaire was distributed to all patients visiting the derrnatology clinics of King Khalid University Hospital during the period of July to September 2010. The patients were selected for participation at the end of their visit if they were first seen by a dermatology resident alone and then by a consulting dermatologist. The survey included questions regarding sociodemographic factors, number of visits to the dermatology clinic, understanding of the resident's role, and the level of satisfaction regarding resident participation in patient care. The global satisfaction questions were assessed using a 5-point Likert-type scale. The patients were also asked about their perception of resident involvement in taking a medical history, performing physical examinations, writing prescriptions, performing a skin biopsy or a minor surgical procedure, providing cosmetic consultations, and providing heahh education. SPSS version 16 (SPSS Inc., Chicago, IL) was used. Numerical variables were reported as the mean ± standard deviation. The chi-square test was used to assess the associations between different categorical variables. The statistical significance was based on p values < .05. Ordinal logistic regression was used to relate the ordinal outcome variables, such as patient understanding of resident physicians' roles, attitude toward physical examination by resident physicians, and attitude toward undergoing a skin biopsy performed by resident physicians, with the patients' demographic and clinical variables. Both univariate (unadjusted) and multivariate (adjusted) associations were examined and presented.
Methods This study was a cross-sectional survey conducted using patients who attended dermatology outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia.The specially designed questionnaire used for the data collection in this study was pilot-tested three times on 30 subjects each to estimate the time required to complete the questionnaire, ensure the participants' comprehension of the questions, and refine the questions if necessary. These pilot-tested questionnaires were excluded from the final analysis. The final questiormaire included 25 questions
Results The questionnaire was distributed to 900 patients. In total, 742 respondents returned the questionnaire (82% response rate). The sociodemographic characteristics of the participating patients are shown in Table 1. The mean respondent age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The mean number of clinic visits was 3.76 ± 3.76. At the time of the study, 27.1% (200 of 737) of the patients completed their first visit and 17.1% (126 of 737)
' Canadian Dermatology Association I Journal of Cutaneous Medicine and Surgery, Vol 18, No 1 (January/February), 2014: pp 20-27
21
AlGhamdi et al
Table 1 Sociodemographic Data of the Participants in the Survey (a cohort of 742 Saudi patients) Variable Age group(yr) Below 30 30-40 Above 40 Gender Male Female Educational level Secondary school education and below University education or higher Residence Urban Rural Occupation Employee/businessperson Student Unemployed Average household monthly income (SR)* < 5,000 5,001-20,000 > 20,000
j;
%
322/564 142/564 100/564
57.1 25.2 17.7
311/742 431/742
41.9 58.1
280/742 461/742
37.9 62.1
714/739 24/739
96.8
l'uni)! Tôimi
39.6 34.2 26.2
193/737
209/710 441/710 60/710
3.2
29.4 62.1 8.5
*3.75 Saudi riyals (SR) = 1 US dollar.
completed their second visit. Overall, 73% of the respondents had four visits or fewer at the time of the study. Additionally, 65.8% of the participants had previously visited the consultant in a private clinic or knew about him or her before this visit. Moreover, 67.6% of the patients insisted on the presence of the consultant
during each visit. Regarding the aim of the visit, 80.4% of the patients came for a medical dermatology consultation, 3.2% came for a surgical intervention, and 10.7% were interested in cosmetic advice. An accurate understanding of a resident's position was indicated by 35% of the patients, whereas 65% thought that a resident might be a student, an intern, or a physician who had completed his or her postgraduate studies. Overall, 67.8% of the patients were previously evaluated by a resident in the dermatology clinic, and 93.5% of the patients had a positive experience. The percentage of respondents who were evaluated by a male resident during the current visit was 45%. The resident's behavior was excellent according to 86.4% of the patients and good or fair according to 13.7%. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the resident. Varying percentages of patients responded favorably to resident participation in various aspects of their health care (Figure 1). The highest level of patient satisfaction was reported for completing a medical history and providing advice by residents (87.6% and 86.3%, respectively). The lowest satisfaction levels were for skin biopsy and malignant tumor excision by a resident (37.6%. and 29.5%, respectively). Table 2 shows no associations between patients' understanding of the resident physician position (finished postgraduate/preparing for postgraduate studies/intern or medical student) and their demographic and clinical characteristics. As indicated in Table 3, education level was associated with patients' attitudes toward agreeing to undergo a physical examination by a resident. Patients who had a
100
Figure 1. Percentage of dermatology outpatients agreeing to resident participation in various aspects of their health care.
Giving advice
Cosmetic corsultation
malignant tumor
Doingsl
Perceptions, Attitudes, and Satisfaction Concerning Resident Participation in Health Care among Dermatology Outpatients Khalid M. AlGhamdi, Hind M. AlMohanna, Salim S. AlKeraye, Fahad M. AlSaif, and Saleh K. AlRasheed
Background: A limited number of published studies have discussed patient attitudes toward resident physicians' participation in dermatology clinics. A literature search failed to identify any such study in the Middle East. Objective: The aim of this study was to explore patient perceptions and attitudes toward resident participation in dernnatology outpatient clinics. Methods: A self-administered questionnaire focused on patient attitudes toward dermatology resident participation was distributed randomly to all adult outpatients attending dermatology clinics at a university hospital in Saudi Arabia between July and September 2010. Results: The questionnaire was returned by 742 of 900 patients, for an 82% response rate. The mean patient age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The major reason for visiting the hospital was a medical dermatology consultation (80.4%). Only 35% of the patients self-reported an accurate understanding of the "resident" designation. In total, 86.4% of patients were satisfied with the residents' behavior. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the residents. The patients agreed with resident participation in their health care. The majority of the patients expressed their willingness to provide a medical history and receive counseling from residents (87.6% and 86.3%, respectively). There was no gender-associated effect on the understanding of the resident position or the decision to receive a physical examination by a resident. Conclusion: Dermatology outpatients are satisfied and have positive perceptions and attitudes toward resident participation in the dermatology clinic. Contexte: Peu d'études publiées portent sur les attitudes des patients à l'égard de la participation des résidents en dermatologie, et un examen de la documentation n'a pas permis de relever d'étude en la matière, au Moyen-Orient. Objectif: L'étude visait à examiner les perceptions et les attitudes des patients à l'égard de la participation des résidents en dermatologie externe. Méthode: Un questionnaire à remplir soi-même, portant sur les attitudes des patients à l'égard de la participation des résidents en dermatologie a été remis au hasard à tous les adultes externes qui sont allés consulter en dermatologie, dans un hôpital universitaire, en Arabie Saoudite, de juillet à septembre 2010. Résultats: Au total, 742 patients sur 900 ont rempli le questionnaire, ce qui a porté à 82% le taux de réponse. L'âge moyen était de 30.58 ± 11.67 ans, et 42% (311 sur 742) des répondants étaient des hommes. Le principal motif de visite à l'hôpital était une consultation médicale en dermatologie (80.4%). Seuls 35% des patients ont indiqué avoir une bonne compréhension du titre de résident. En tout, 86.4% des répondants se sont dits contents du comportement des résidents. Qui plus est, 98.4% des patients étaient satisfaits des soins médicaux donnés par les résidents. Les patients étaient d'accord sur la participation des résidents à la prestation des soins de santé. La plupart des patients se sont montrés disposés à fournir des renseignements sur leurs antécédents médicaux aux résidents et à recevoir des conseils d'eux (87.6% et 86.3%, respectivement). Aucun effet lié au sexe quant à la compréhension du rôle de résident ou à la décision de subir un examen physique par un résident n'a été relevé.
From the Dermatology Department, College of Medicine, King Saud University, Riyadh, Saudi Arabia. Address reprint requests to: Khalid M. AlGhamdi, MD, Dermatology Department, College of Medicine, King Saud University, PO Box 240997, Riyadh 11322, Saudi Arabia; e-mail: kmgderm@yahoo,com.
^ O I 10.2310/7750.2013.13010 © 2014 Canadian Dermatology Association
DECKEI^ ' 20
Canadian Dermatology Association I Journal of Cutaneous Medicine and Surgery, Vol IS, No 1 (January/February), 2014: pp 20-27
Outpatient Perceptions, Attitudes, and Satisfaction Concerning Resident Participation
Conclusions: Les malades externes en dermatologie sont satisfaits de la participation des résidents en dermatologie et ont des perceptions et des attitudes favorables à l'égard de leur rôle.
ESIDENCY TRAINING PROGRAMS necessitate resident participation in dermatology clinics. As a resuit, residents gain knowledge and practice experience and improve their clinical skills. Patients' attitudes toward residents are variable, and several factors play a role in determining patient perceptions.' An assessment of health care quality through satisfaction measurements is essential.^'^ Earlier studies have shown high patient satisfaction levels in other medical disciplines.' Few studies discuss patient attitudes toward resident participation in outpatient clinics.''*""' In general, patients are satisfied when being treated by residents in dermatology and community teaching clinics.'''' Respondents recognize the importance of training new physicians, although they prefer being seen by the same doctor repeatedly.* In terms of clinical skills, the majority of patients agree that the residents' skills were equivalent to those of the ordinary physician.* Moreover, the patients perceived advantages to being treated by a resident. For instance, residents provided longer consultation times and shorter waiting times.* However, it is often assumed that the attitudes of patients toward residents in their health care might be negative. To the best of our knowledge, this is the first study discussing the impact of residents' contribution to the care of patients attending dermatology clinics in the Middle East. It is the second study performed worldwide; the first study was conducted in the United States.' The aim of this study was to evaluate dermatology outpatients' perceptions, attitudes, and satisfaction regarding resident participation in their care.
and required approximately 8 minutes to complete (Appendix). This study was approved by the local ethics committee. A self-administered questionnaire was distributed to all patients visiting the derrnatology clinics of King Khalid University Hospital during the period of July to September 2010. The patients were selected for participation at the end of their visit if they were first seen by a dermatology resident alone and then by a consulting dermatologist. The survey included questions regarding sociodemographic factors, number of visits to the dermatology clinic, understanding of the resident's role, and the level of satisfaction regarding resident participation in patient care. The global satisfaction questions were assessed using a 5-point Likert-type scale. The patients were also asked about their perception of resident involvement in taking a medical history, performing physical examinations, writing prescriptions, performing a skin biopsy or a minor surgical procedure, providing cosmetic consultations, and providing heahh education. SPSS version 16 (SPSS Inc., Chicago, IL) was used. Numerical variables were reported as the mean ± standard deviation. The chi-square test was used to assess the associations between different categorical variables. The statistical significance was based on p values < .05. Ordinal logistic regression was used to relate the ordinal outcome variables, such as patient understanding of resident physicians' roles, attitude toward physical examination by resident physicians, and attitude toward undergoing a skin biopsy performed by resident physicians, with the patients' demographic and clinical variables. Both univariate (unadjusted) and multivariate (adjusted) associations were examined and presented.
Methods This study was a cross-sectional survey conducted using patients who attended dermatology outpatient clinics at King Khalid University Hospital in Riyadh, Saudi Arabia.The specially designed questionnaire used for the data collection in this study was pilot-tested three times on 30 subjects each to estimate the time required to complete the questionnaire, ensure the participants' comprehension of the questions, and refine the questions if necessary. These pilot-tested questionnaires were excluded from the final analysis. The final questiormaire included 25 questions
Results The questionnaire was distributed to 900 patients. In total, 742 respondents returned the questionnaire (82% response rate). The sociodemographic characteristics of the participating patients are shown in Table 1. The mean respondent age was 30.58 ± 11.67 years. Forty-two percent (311 of 742) of the respondents were male. The mean number of clinic visits was 3.76 ± 3.76. At the time of the study, 27.1% (200 of 737) of the patients completed their first visit and 17.1% (126 of 737)
' Canadian Dermatology Association I Journal of Cutaneous Medicine and Surgery, Vol 18, No 1 (January/February), 2014: pp 20-27
21
AlGhamdi et al
Table 1 Sociodemographic Data of the Participants in the Survey (a cohort of 742 Saudi patients) Variable Age group(yr) Below 30 30-40 Above 40 Gender Male Female Educational level Secondary school education and below University education or higher Residence Urban Rural Occupation Employee/businessperson Student Unemployed Average household monthly income (SR)* < 5,000 5,001-20,000 > 20,000
j;
%
322/564 142/564 100/564
57.1 25.2 17.7
311/742 431/742
41.9 58.1
280/742 461/742
37.9 62.1
714/739 24/739
96.8
l'uni)! Tôimi
39.6 34.2 26.2
193/737
209/710 441/710 60/710
3.2
29.4 62.1 8.5
*3.75 Saudi riyals (SR) = 1 US dollar.
completed their second visit. Overall, 73% of the respondents had four visits or fewer at the time of the study. Additionally, 65.8% of the participants had previously visited the consultant in a private clinic or knew about him or her before this visit. Moreover, 67.6% of the patients insisted on the presence of the consultant
during each visit. Regarding the aim of the visit, 80.4% of the patients came for a medical dermatology consultation, 3.2% came for a surgical intervention, and 10.7% were interested in cosmetic advice. An accurate understanding of a resident's position was indicated by 35% of the patients, whereas 65% thought that a resident might be a student, an intern, or a physician who had completed his or her postgraduate studies. Overall, 67.8% of the patients were previously evaluated by a resident in the dermatology clinic, and 93.5% of the patients had a positive experience. The percentage of respondents who were evaluated by a male resident during the current visit was 45%. The resident's behavior was excellent according to 86.4% of the patients and good or fair according to 13.7%. Furthermore, 98.4% of the patients were satisfied with the medical care provided by the resident. Varying percentages of patients responded favorably to resident participation in various aspects of their health care (Figure 1). The highest level of patient satisfaction was reported for completing a medical history and providing advice by residents (87.6% and 86.3%, respectively). The lowest satisfaction levels were for skin biopsy and malignant tumor excision by a resident (37.6%. and 29.5%, respectively). Table 2 shows no associations between patients' understanding of the resident physician position (finished postgraduate/preparing for postgraduate studies/intern or medical student) and their demographic and clinical characteristics. As indicated in Table 3, education level was associated with patients' attitudes toward agreeing to undergo a physical examination by a resident. Patients who had a
100
Figure 1. Percentage of dermatology outpatients agreeing to resident participation in various aspects of their health care.
Giving advice
Cosmetic corsultation
malignant tumor
Doingsl
