Circulation 80,350 • Volume 21, No. 1 • Spring 2006   Issue PDF

Residency Programs Need To Emphasize Dialogue Skills

Anthony Peluso, MD

To the Editor

For those of us involved in residency education, the article in the Winter 2005–2006 issue of the APSF Newsletter entitled “Patient Perspectives Personalize Patient Safety”1 should serve as a reminder that the foundation for establishing effective communication after catastrophic events begins with instruction in basic physician-patient dialogue. The attainment of competency in interpersonal and communication skills as required by the Accreditation Council for Graduate Medical Education can begin by innovative teaching tools and exercises. For the past 2 years, we have used letters from patients who express disappointment in care or formal complaints regarding their perioperative experience as a springboard for discussing effective ways to respond in an organized, empathetic manner.

Instruction in letter composition incorporates the acronym AREA (acknowledgment, regret, explanation, assurance). Our residents are taught that the patient’s sentiments must be acknowledged. Whether the physician agrees with the patient’s perception of his/her experience is irrelevant: the only reality is the patient’s perception. Expression of regret can be very comforting for the patient. Disappointment by the treating physician that certain events led to patient dissatisfaction is just as important in validating the patient’s feelings as acknowledgment. An explanation of the events that may have led to a complication or dissatisfaction in the care received is pivotal for resolution. Using layman’s language will illuminate facts and fill in knowledge gaps that help the patient understand the chain of events that led to a negative experience. And finally, but by no means less important, assurance is provided that systems changes will be implemented that will reduce the likelihood that someone else might experience the same complication or maloccurrence.

Anthony Peluso, MD Chairman and Program Director University of Connecticut/Hartford Hospital Anesthesiology Residency Program


1. Eichhorn JH. Patient perspectives personalize patient safety. APSF Newsletter 2005-2006;20(4):61-6.