Physicians' Knowledge and Self-Reported Compliance Promotion as Predictors of Performance with Simulated Lung Disease Patients

Scores on a test of knowledge of chronic lung disease and self-reports of actions to enhance compliance in chronic-disease patients were obtained from 42 primary-care physicians. Tvo years latereach physician was audiotaped during encounters with two simulated lung disease patients. Transcripts were used to scorephysician performance and to analyze communication. Audiotapes of the encounters were alsoplayed to role-playing subjects (N = 252) to ascertain likely patient outcomes. More knowledgeable physicians displayed more clinical expertise, gave more patient education, engaged in less social-emotional talk and induced more satisfaction and recall by role-playing subjects. Physicians who said they worked harder to achieve compliance were shown to be more likely to ask more appropriate open-ended questions, ask more questions, offer less patient education, give more directions and instructions, and make more utterances.

Evaluation of a communication skills program for first-year medical students at the University of Toronto

BACKGROUND

Effective doctor-patient communication has been linked to numerous benefits for both patient and physician. The purpose of this study was to evaluate the effectiveness of the University of Toronto's Therapeutic Communication Program (TCom) at improving first-year medical students' communication skills.

METHODS

Data were collected during the 1996/97, 1997/98, 1998/99 and 1999/00 academic years. The study used a repeated measures design with a waiting list control group: students were randomly assigned to groups starting the educational intervention in either September (N = 38) or February (N = 41), with the latter being used as a control for the former. Communication skills were assessed at the pre- and post-intervention times and at the end of the academic year from the perspectives of student, standardized patient and external rater.

RESULTS

Only the external rater, using an instrument designed to assess the students' empathy based on their written responses, showed a time x group interaction effect (p = 0.039), thereby partially supporting the hypothesis that TCom improved the students' communication skills. Students rated themselves less positively after participation in the program (p = 0.038), suggesting that self-evaluation was an ineffective measure of actual performance or that the program helped them learn to more accurately assess their abilities.

CONCLUSION

The lack of strong findings may be partly due to the study's small sample sizes. Further research at other medical or professional schools could assess the effectiveness of similar courses on students' communication skills and on other capacities that were not measured in this study, such as their understanding of and comfort with patients, their management of the doctor-patient relationship, and their ability to give and receive feedback.

Acquisition of communication skills in postgraduate training for general practice

PURPOSE

The evidence suggests that a longitudinal training of communication skills embedded in a rich clinical context is most effective. In this study we evaluated the acquisition of communication skills under such conditions.

METHODS

In a longitudinal design the communication skills of a randomly selected sample of 25 trainees of a three-year postgraduate training programme for general practice were assessed at the start and at the end of training. Eight videotaped real life consultations were rated per measurement and per trainee, using the MAAS-Global scoring list. The results were compared with each other and with those of a reference group of 94 experienced GPs.

RESULTS

The mean score of the MAAS-Global was slightly increased at the end of training (2.4) compared with the start (2.2). No significant difference was found between the final results of the trainees and the reference group. According to the criteria of the rating scale the performance of both trainees and GPs was unsatisfactory.

CONCLUSION

The results of this study indicate that communication skills do not improve in a three-year postgraduate training comprising both a rich clinical context and a longitudinal training of communication skills, and that an unsatisfactory level still exists at the end of training. Moreover, GPs do not acquire communication skills during independent practice as they perform comparably to the trainees. Further research into the measurement of communication skills, the teaching procedures, the role of the GP-trainer as a model and the influence of rotations through hospitals and the like, is required.

Interviewing skills: self-evaluation by medical students

In an independent learning project, 52 third-year medical students carried out a structured self-assessment of two videotaped psycho-social interviews they had conducted with volunteer clients 1 year earlier, as part of a previous course. The interviews had been conducted in small tutorials with feedback from their clients, fellow students and tutors, facilitated by videotape playback. During the sequence of 16 tutorials each student had carried out an early and a late interview and had observed and participated in the discussion of the interviews of 14 peers. Students were asked to tally the frequencies of various interview behaviours, to evaluate the quality of their behaviours, and to establish priorities for future learning. The videotapes were also reliably rated by an independent observer. Students' overall self-assessments correlated 0.46 with those of the independent observer. This correlation was higher than is typically reported in studies of the validity of self-assessment. In absolute terms, the students' mean rating of interviewing performance was 3.2 (adequate plus) which was significantly lower than the observer's mean of 3.6 (adequate to good). Results are discussed in terms of Gordon's (1992) two recommendations for improving the validity of self-assessments and two further suggestions, for paired comparisons and low-threat learning environments, are added.

Videotaped interviewing of non-English speakers: training for medical students with volunteer clients

In a multicultural society such as Australia, with over 20% of its population born overseas, interpreters are often required to facilitate medical interviews. However, where a patient has some proficiency in English, medical interviews are sometimes conducted across the boundaries of culture and language. This is a report of an educational innovation to teach interviewing skills to pre-clinical medical students with the assistance of volunteers of non-English-speaking backgrounds. Pre-clinical students interviewed community volunteers on topics of general life history in a sequence of 16 tutorials. Each student conducted two interviews. Teaching methods included feedback from the volunteers, tutorial discussion facilitated by playback of videotapes, and modelling of skills by the teachers. Evaluations by volunteers and students indicated high satisfaction with the teaching methods and outcomes. Students gained confidence in interviewing people from different cultures. Evaluation of students' pairs of videotapes by an independent rater achieved satisfactory reliabilities and indicated significant gains in inquiry skills and the communication of positive attitudes. Skills in communicating empathy and in using simple language did not improve measurably.

Workshops for consultants on the teaching of clinical communication skills

A group of senior medical school staff concerned about the short-lived effects of communication training formed the Medical Interview Teaching Association. They felt that communication training needed to be reinforced throughout the curriculum and that this would need active involvement by large numbers of consultants. To achieve this they planned a series of workshops. Seventeen consultants and eight other senior staff agreed to participate in the pilot workshop. This was a 3 1/2-day residential workshop. The structure was adapted from a 'faculty development' model used successfully in the USA. Participants worked mostly in small groups helped by experienced facilitators. The teaching style was learner centred and therefore the details of the problem-based agenda and the choice of working methods were largely determined by the participants themselves. There were also some conventional lectures and demonstrations. Evaluation was by postal questionnaire 2 weeks later. This requested both qualitative comments and Likert scale ratings about every aspect of process and outcome. Most responses were strongly positive. Participants felt they made good progress in developing new skills and new curriculum ideas. They also felt more motivated and self-aware as teachers. The learner-centred approach and the diversity of learning activities were seen as very useful. The unstructured approach to self-awareness training was felt to be less useful. It is concluded that such workshops could well lead to more effective communication training and may also have wider implications for medical education.

Verbal communication skills and patient satisfaction. A study of doctor-patient interviews

This research attempted to quantify specific behaviors in the physician's initial interviewing style and relate them to patients' perception of satisfaction. Five physicians were tape recorded during their initial interviews with 52 adult patients. The patients were asked to complete the Medical Interview Satisfaction Scale, a 29-item instrument with a 7-point response scale. These interviews were transcribed, timed, coded, and analyzed with the use of the Computerized Language Analysis System. Selected variables of the language dimensions were entered as the predictor variables in a multiple regression, along with satisfaction scores as the dependent variables. Twenty-seven percent of the variance (p less than .01) in the satisfaction scores of initial interviews were explained by three aspects of a physician's language style: (a) use of silence or reaction time latency between speakers in an interview, (b) whether there was language reciprocity as determined through the reciprocal use of word-lists, and (c) the reflective use of interruptions within an interview. Considering the complexity of human communication, the fact that three variables were identified, which accounted for 27% of the variance in patients' satisfaction, is considered a substantial finding.

To what extent are medical interviewing skills teachable?

Growth patterns of medical interviewing skills during a 6-year undergraduate curriculum are assessed by studying 563 medical students taken from five year-groups, interviewing simulated patients. In a cross-sectional, quasi-experimental design their skills are rated by means of the Maastricht History-taking and Advice Checklist (MAAS), an observation instrument which measures five categories of interviewing skills pertaining to initial medical consultations. The findings suggest that the skills for 'history-taking', 'presenting solutions' and 'structuring of the interview' are effectively learned. These learning effects result from a continuous small group teaching program with expert and peer review of videotaped encounters with simulated patients. The teaching effects of this program seem less for the skills pertinent to the phase of 'exploring the reasons for encounter' and to the 'basic interviewing skills', because the students' growing medical knowledge and the increasing ability to solve medical problems exert a counteracting influence on the acquisition of these easily deteriorating skills. The results might be helpful to curriculum planners in order to make their programs for medical interviewing skills more effective.

The teacher simulation exercise: changes in physician teaching emphasis and strategy. The SGIM Task Force on the Medical Interview

OBJECTIVES

The objective of the study was to determine the effect of a faculty development course in teaching medical interviewing on participants' ability to provide effective feedback to interviewers.

DESIGN

The study used a non-concurrent control group design which randomized subjects into two groups before the intervention. The two groups completed different pre-tests; each group then completed the other group's pre-test as its post-test. The post-course scores of one group were compared with the pre-course scores of the other group to establish differences.

SETTING

The research was conducted at the 1985 faculty development course sponsored by the SGIM Task Force on the Medical Interview.

PARTICIPANTS

49 of 52 teachers of medical interviewing attending the course completed the study.

INTERVENTION

The week-long intervention consisted of a variety of educational activities which assisted the participants in defining and actively pursuing their learning objectives in interviewing, teaching, and self-awareness.

MEASUREMENTS AND MAIN RESULTS

In their assessment of two videotaped segments of initial medical visits, participants were more likely after the course to comment on the interviewer's lack of attention to patient affect (69.0% versus 27.2%, p = 0.005 in one segment) and somewhat more likely to identify teaching strategies that actively involved the interviewer (47.2% vs. 35.0%, p = 0.09 in one segment). Both shifts were congruent with assessments made by course faculty.

CONCLUSIONS

Faculty development can influence teachers to recognize the need to provide feedback on skills that expert teachers would emphasize. The non-concurrent control group design provides an innovative approach to common constraints in evaluating faculty development courses.

Evaluation of a medical interviewing course. Use of the helping relationship inventory

Changes in beginning medical students' preferred interview responses appear attributable to a course that emphasizes communication techniques for developing patient rapport. For each of five successive classes, pre/postcourse preferences were obtained for alternative response modes (categorized as understanding, probing, interpretive, supportive, and evaluative. Analysis indicated significant increases in students' preferences for understanding responses and decreases in preferences for evaluative responses (p less than .001). Changes are in the desired direction with respect to course goals, since rapport is generally enhanced by conveying understanding and refraining from premature evaluation. Effects on response preferences of some instructor characteristics are analyzed. Implications for health professions education and research are discussed.

An evaluation of the short-term effects of an interpersonal skills course

A course on interpersonal skills (IPS) has been introduced as part of the clerkship in internal medicine. The course is given in small groups (8-10 students) with two tutors attached to each group. The use of trigger films in the IPS course has been described previously (Alroy & Ber, 1982). An evaluation of the short-term (2-month) effects of the method is now reported.

Teaching health education in medical education: selected perspectives

Growing awareness of the need to incorporate prevention and psychosocial considerations into medical care practice has led to the inclusion of formal health education curricula in medical schools and residency programs. This paper examines the role of health education in medical education from several perspectives: an historical background, a review of the literature, and a characterization of current programs in the United States.