Internal Medicine Trainee Self-Assessments of End-of-Life Communication Skills Do Not Predict Assessments of Patients, Families, or Clinician-Evaluators

Purpose: To investigate the strength of association between trainees' self-assessments of the quality of their end-of-life communication skills and the assessments of their patients, patients' families, and clinician-evaluators. Methods: As part of a randomized trial, pre-intervention survey data were collected at two sites from internal medicine trainees and their patients, patients' families, and clinician-evaluators. In this observational analysis, comparisons using regression analysis were made between (1) trainees' scores on a scale of perceived competence at communication about end-of-life care and (2) patients', families', and clinician-evaluators' scores on a questionnaire on the quality of end-of-life communication (QOC). Secondary analyses were performed using topic-focused subscales of these measures. Results: Internal medicine trainees (143) were studied with both self-assessment and external assessments. No significant associations were found between trainee perceived competence scores and primary outcome measures (p > 0.05). Of the 12 secondary subscale analyses, trainees' self-ratings were significantly associated with external assessments for only one comparison, but the association was in the opposite direction with increased trainee ratings being significantly associated with decreased family ratings on treatment discussions. We also examined the correlation between ratings by patients, family, and clinician-evaluators, which showed significant correlations (p < 0.05) for 7 of 18 comparisons (38.9%). Conclusions: Trainee self-evaluations do not predict assessments by their patients, patients' families, or their clinician-evaluators regarding the quality of end-of-life communication. Although these results should be confirmed using the same measures across all raters, in the meantime efforts to improve communication about end-of-life care should consider outcomes other than physician self-assessment to determine intervention success.