Development and Validation of the Pediatric Physician Interpersonal Communication Skills Assessment of Emergency Physicians by Pediatric Patients and Their Caregivers

Objective: The objective was to develop and validate an evaluation tool containing scaled items with behaviorally descriptive responses for pediatric patients and their caregivers (PCs) to evaluate and provide anonymous constructive feedback regarding interpersonal communication skills of pediatric emergency department (ED) physicians. Methods: A multistep validity-driven approach consisting of literature review, structured input by subject matter experts, and end-user focus group reviews was conducted to develop the Pediatric Physician Interpersonal Communication Skills Assessment (P-PICSA) tool. Study subjects were enrolled prospectively (2011–2015). Psychometric analysis included exploratory factor analysis (EFA), confirmatory factor analysis (CFA), and item response analysis. Cronbach’s alpha coefficient to determine internal consistency of subscale items, Pearson's correlation coefficient to estimate interscale correlations, and Spearman rank correlation coefficient to assess correlations between physician scores and ED factors that influence PC evaluations were calculated. Results: First-order EFA of 389 evaluations for 98 physicians yielded a two-factor model: 1) physician engagement of PCs (six items) and 2) physician delivery of information to PCs (seven items). An additional 3,089 evaluations for 128 physicians were collected to test factor structure and scale quality. CFA was conducted on calibration (n = 1,222) and validation (n = 1,190) samples. A two-factor structure was confirmed with satisfactory fit for both samples. Cronbach's alpha was 0.81 for factor 1 and 0.87 for factor 2. Physicians received lower scores if PCs perceived nonrespectful behavior from nonphysician staff or long ED lengths of stay, completed the Spanish version of the P-PICSA, or were admitted to the hospital. Conclusion: The P-PICSA is a reliable and valid tool for pediatric PCs to evaluate pediatric ED physicians’ interpersonal and communication skills. Compared to Likert-type rating scales, the P-PICSA’s behaviorally descriptive response items may provide ED physicians with more descriptive feedback and direction for skills improvement.