Modeling the role of rapport and classroom climate in EMI students' classroom engagement

With the globalization of education, an increasing number of studies have been carried out in the English as a medium of instruction (EMI) classes. However, as the review of earlier studies revealed, most of the studies have exclusively focused on the challenges and opportunities of this mode of instruction. That is, few investigations have examined students' classroom behaviors and their determinants in EMI courses. More precisely, limited attention has been dedicated to EMI students' classroom engagement and its potential predictors. Accordingly, studying EMI students' classroom engagement and its personal, interpersonal, and situational predictors seems essential. To respond to this necessity, the present research examined the role of rapport and classroom climate in predicting Chinese EMI students' classroom engagement. In doing this, using random sampling strategy, a total of 416 university students was recruited from Chinese EMI classes. To collect the dataset, an online survey comprising three self-report questionnaires was administered to participants. The results of correlation test and multiple regression analysis divulged positive, significant correlations among rapport, classroom climate, and classroom engagement. The analysis outcomes also displayed that rapport and classroom climate were significant predictors of EMI students' classroom engagement. The study outcomes may have some beneficial and insightful implications for all instructors teaching different academic subjects through English.

Antecedents of rapport and its mediating role on relational cohesion in patient-physician interaction

Increasing competition in healthcare services, it is imperative that physicians and family-care practitioners seek ways to attract and retain patients. Building relationships with existing patients is one sure way to continued patronage and increased clientele. The purpose of this paper is to examine antecedents of rapport and its influence on perceived relationships in the context of patient-physician interaction. Study using cross-sectional survey method with structured questionnaire was used for data collection. Structural Equation Modeling was used for analyzing the data collected from 326 patients residing in Karnataka, India. The finding suggests that respect, responsibility and understanding have significant influence on relational cohesion with rapport acting as mediating variable. The results add to the empirical validity of the relationship among rapport, respect & relationship, as it is required to understand studied in Indian context. The finding provides new directions for both healthcare professionals and institutions in their endeavor of building relationships with their customers (Patients) by emphasizing the need for developing 'rapport' as an integral part of service interaction. Future research like longitudinal and experimental studies can provide more conclusive evidence regarding the influence of service behaviour on rapport.

Forensic interviewers' difficulty with the birthday narrative

BACKGROUND

Narrative practice increases children's productivity in forensic interviews, and one recommended topic is the child's last birthday, though interviewers have raised concerns about its productivity. STUDY 1 OBJECTIVE: Study 1 surveyed forensic interviewers' use of and attitudes about the birthday narrative.

PARTICIPANTS AND SETTING

Participants included 170 forensic interviewers who subscribed to a webinar promoting use of the birthday narrative (Mage = 43 years, SD = 10.2, 94 % female).

RESULTS

Over half (55 %) of interviewers reported that they rarely/never asked about children's birthdays, and non-users were especially likely to view the birthday narrative as never/rarely productive. Although interviewers viewed memory difficulties as more likely to occur with the birthday narrative than other practice topics (the child's likes, the child's day), non-users did not view memory difficulties, reluctance, generic reports, or religious objections as especially problematic. Open-ended responses identified negative experiences with the birthday as an additional concern, and interviewers' recommended wording of the prompts suggested suboptimal questioning strategies. STUDY 2 OBJECTIVE: Study 2 assessed the use of the birthday narrative in forensic interviews.

PARTICIPANTS AND SETTING

The sample included 350 forensic interviews with 4- to 12-year-old children (Mage = 8.85, SD = 2.59).

RESULTS

Only 4 % of children failed to recall substantive information if interviewers persisted, though another 11 % failed when interviewers stopped persisting. Invitations were more effective than other question types, especially among older children. 21 % of children mentioned a negative detail during their narrative.

CONCLUSIONS

Interviewers' skepticism about the birthday narrative may be due to suboptimal questioning and sensitivity to occasional failures and negative information.

Rapport: A conceptual definition from the perspective of patients and families receiving palliative care

OBJECTIVE

To explore patient and family perceptions of rapport in interactions with health professionals and use the findings to develop a conceptual definition of rapport.

METHODOLOGY

We undertook a qualitative Interpretive Description study; semi-structured interviews were conducted between November 2020 and May 2021. Participants included 18 patients and 11 family members recruited using a random approach from four hospice locations in Aotearoa, New Zealand. Interviews were audio recorded, transcribed, and analysed to develop a conceptual definition of rapport using guidelines (Podsakoff et al., (2016). A COREQ checklist was completed.

RESULTS

Four dimensions of rapport were identified which formed the basis of a conceptual definition: 1) the type of relating, 2) the essence of rapport experienced, 3) key communication characteristics, and 4) the effect on interactions.

CONCLUSION

Based on patient and family experiences of rapport, this study formulated a conceptual definition of rapport. This definition will support clinical education and practice and inform future research related to rapport.

PRACTICE IMPLICATIONS

A conceptual definition of rapport can provide clarity for both research and clinical practice. It may be used as a tool for health professionals to reflect upon their experiences with rapport and develop expertise in this area.

Interviewing in virtual environments: Towards understanding the impact of rapport-building behaviours and retrieval context on eyewitness memory

Given the complexities of episodic memory and necessarily social nature of in-person face-to-face interviews, theoretical and evidence-based techniques for collecting episodic information from witnesses, victims, and survivors champion rapport-building. Rapport is believed to reduce some of the social demands of recalling an experienced event in an interview context, potentially increasing cognitive capacity for remembering. Cognitive and social benefits have also emerged in remote interview contexts with reduced anxiety and social pressure contributing to improved performance. Here, we investigated episodic memory in mock-eyewitness interviews conducted in virtual environments (VE) and in-person face-to-face (FtF), where rapport-building behaviours were either present or absent. Main effects revealed when rapport was present and where interviews were conducted in a VE participants recalled more correct event information, made fewer errors and were more accurate. Moreover, participants in the VE plus rapport-building present condition outperformed participants in all other conditions. Feedback indicated both rapport and environment were important for reducing the social demands of a recall interview, towards supporting effortful remembering. Our results add to the emerging literature on the utility of virtual environments as interview spaces and lend further support to the importance of prosocial behaviours in applied contexts.

The Effects of Rapport Building on Information Disclosure in Virtual Interviews

Rapport building has been identified as an effective tool when interviewing victims and witnesses of events that may be sensitive in nature. The objective of this study was to examine the rapport-building process within a virtual interviewing context. Participants (N = 94) were shown a sexual education video and then questioned about the content of the video in a live virtual interview using either a rapport (e.g., empathy, personalization, smiling) or no-rapport (e.g., flat tone, no smiling, no personalization) approach. Results showed that perceived rapport was much higher in the rapport condition compared to the no-rapport condition (d = 1.47). Participants in the rapport condition also provided substantially more dialog (d = 0.85) and reported more accurate details (d = 0.42) in the substantive phase of the interview than those in the no-rapport condition. Implications of this study for investigative interviews conducted virtually will be discussed.

A discourse analysis of health provider interactions with parents who are reluctant to vaccinate

OBJECTIVE

Vaccine hesitancy is a persistent barrier to vaccination uptake, and health professionals report interactions with such parents to be difficult. Using discourse analytic techniques, we examine the foundation of a therapeutic relationship: the display of empathy and attempts to build rapport, in consultations between immunisation specialists and vaccine reluctant parents.

METHODS

Consultations between consenting clinicians and parents in two Specialist Immunisation Clinics in Australia were recorded. Twelve conversations between the clinicians and parents were analysed using interactional sociolinguistic (IS) discourse analytic methods.

RESULTS

This paper takes a case study approach by citing two interactions that exemplify the interactional work of the consultants as they strive to engender mutual understanding and goodwill, noting examples of discursive choices that demonstrate empathy and the building of rapport.

CONCLUSION

Awareness of discourse strategies that interweave relational and clinical goals enable a more nuanced understanding of communication skills that support a guiding partnership in vaccine related decisions with parents.

PRACTICAL IMPLICATIONS

Through highlighting the strategic interactional work that displays empathy and builds rapport, we can inform educational approaches and build a repertoire of communication choices that strengthen the communication skills of health professionals.

The Positive Assessment: A Model for Integrating Well-Being and Strengths-Based Approaches into the Child and Adolescent Psychiatry Clinical Evaluation

In traditional medical practice, the diagnostic interview is focused on symptom collection, diagnosis, and treatment. The psychiatric interview is based on the medical model, but mental health clinicians lack the tests found in general medicine. Rapport is the most essential tool for the psychiatrist to uncover symptoms and develop a diagnosis and treatment plan. This article brings a scientific lens to the psychiatric interview. Under this microscope the value of eliciting the patient's well-being at the outset of the interview becomes clear. Using positive psychology, an evidenced-based rationale for the positive assessment is outlined and methodology and practice of the assessment reviewed.

Effects of Presession Pairing on Preference for Therapeutic Conditions and Challenging Behavior

The current study examined child preference for presession therapeutic conditions. A 4-year-old female diagnosed with autism spectrum disorder (ASD) was exposed to three conditions in a concurrent-chains arrangement: presession pairing (PSP) prior to the onset of discrete-trial instruction (DTI), free play (FP) prior to DTI, or immediate onset of DTI. Initial link selections in the concurrent-chains arrangement suggested a relative preference for the PSP condition across multiple therapists. Negative vocalizations decreased across all conditions following implementation of the concurrent-chains arrangement with no differentiation between therapeutic conditions.

Parent perspectives on the clinician-client relationship in speech-language treatment for children

Few studies have explored clinician-client relationships in speech-language treatment for children, although evidence indicates that these relationships may be important. Parents play a unique role in clinician-client relationships and their views have yet to be considered in the speech-language pathology literature. This study explored parents' perspectives on the clinician-client relationship in speech-language treatment for children using both quantitative and qualitative information. An online survey collected responses from 159 parents with children enrolled in speech-language services. Respondents were asked to complete a rating of the clinician-client relationship, provide information on length of treatment and treatment setting, and respond to open-ended questions about what enhances the clinician-client relationship. Length of treatment was unrelated to the parent rating of the clinician-client relationship. However, ratings did vary by treatment setting; parents of children enrolled in treatment services in schools provided lower ratings than parents with children enrolled in other settings. Thematic analysis of parent views on what enhances the clinician-client relationship yielded four main themes: qualities of the speech-language pathologist (SLP), session characteristics, the child-SLP bond, and communication. The most frequent subthemes in the analysis related to characteristics of the sessions: the integration of play and fun, and a child-oriented approach to sessions. These results provide insight into the development of clinician-client relationships in children's speech-language treatment, with implications for both clinicians and researchers.

Developing Procedures to Improve Therapist-Child Rapport in Early Intervention

Rapport is a primary component in the development of a therapeutic relationship between health-service professionals and clients. Presession pairing is a procedure often recommended in behavior analytic practice to build rapport with clients. However, many service providers may not exhibit presession pairing skills correctly or at a sufficient rate. The current study aimed to operationally define therapist behaviors that are indicative of presession pairing and to train direct care staff to implement said skills.

Associations between thin slice ratings of affect and rapport and perceived patient-centeredness in primary care: Comparison of audio and video recordings

OBJECTIVE

To investigate associations between ratings of "thin slices" from recorded clinic visits and perceived patient-centeredness; to compare ratings from video recordings (sound and images) versus audio recordings (sound only).

METHODS

We analyzed 133 video-recorded primary care visits and patient perceptions of patient-centeredness. Observers rated thirty-second thin slices on variables assessing patient affect, physician affect, and patient-physician rapport. Video and audio ratings were collected independently.

RESULTS

In multivariable analyses, ratings of physician positive affect (but not patient positive affect) were significantly positively associated with perceived patient-centeredness using both video and audio thin slices. Patient-physician rapport was significantly positively associated with perceived patient-centeredness using audio, but not video thin slices. Ratings from video and audio thin slices were highly correlated and had similar underlying factor structures.

CONCLUSION

Physician (but not patient) positive affect is significantly associated with perceptions of patient-centeredness and can be measured reliably using either video or audio thin slices. Additional studies are needed to determine whether ratings of patient-physician rapport are associated with perceived patient-centeredness.

PRACTICE IMPLICATIONS

Observer ratings of physician positive affect have a meaningful positive association with patients' perceptions of patient-centeredness. Patients appear to be highly attuned to physician positive affect during patient-physician interactions.

[Report on chronic dialysis in France in 2016]

The report on dialysis in France in 2016 from the French Speaking Society of Nephrology Dialysis and Transplantation (SFNDT) provides an exhaustive and documented inventory on dialysis in France. It underlines the organizations that are important in 2016 to maintain a high quality dialysis. Several measures are proposed to maintain and improve the care of dialysis in France: (1) The regulation of dialysis treatment in France must be maintained; (2) a burden of care indicator is proposed to ensure that patients requiring the most care are treated in the centers. Proposals are also made to stimulate peritoneal dialysis offers, (3) to improve the calculation of the cost of dialysis and warn against lower reimbursement rates of dialysis, (4) to reduce transport costs by minimizing transport by ambulance (5). The SFNDT recalls recent recommendations concerning access to the renal transplant waiting list, are recalled; (6) as well as recommendations that require waiting until clinical signs are present to start dialysis (7). The SFNDT makes the proposal to set up advanced renal failure units. These units are expected to develop care that is not supported today: consultation with a nurse, a dietician, a social worker or psychologist, palliative care, and coordination (8). Finally, the financial and human resources for pediatric dialysis should be maintained.

Treatment of Trauma and Nonsuicidal Self-Injury in Transgender Adults

This article explores the presence of trauma and nonsuicidal self-injury (NSI) in transgender people. We explore the prevalence of trauma and NSI in transgender people, the ways in which these clinical concerns manifest across the lifespan, and special considerations for assessment and treatment. The article concludes by describing the importance of developing a strong rapport with clients and the concept of reasonably well-controlled cooccurring mental health concerns.

'It just has to click': Internists' views of: what constitutes productive interactions with chronically ill patients

Background

According to the Chronic Care Model, productive interactions are crucial to patient outcomes. Despite productive interactions being at the heart of the Model, however, it is unclear what constitutes such an interaction. The aim of this study was to gain a better understanding of physician views of productive interactions with the chronically ill.

Method

We conducted a qualitative study and interviewed 20 internists working in an academic hospital. The data were analyzed using a constructivist approach of grounded theory. To categorize the data, a coding process within which a code list was developed and tested with two other coders was conducted.

Results

The participants engaged in goal-directed reasoning when reflecting on productive interactions. This resulted in the identification of four goal orientations: (a) health outcome; (b) satisfaction; (c) medical process; and (d) collaboration. Collaboration appeared to be conditional for reaching medical process goals and ultimately health outcome and satisfaction goals. Achieving rapport with the patient (‘clicking,’ in the term of the participants) was found to be a key condition that catalyzed collaboration goals. Clicking appeared to be seen as a somewhat unpredictable phenomenon that might or might not emerge, which one had to accept and work with. Goal orientations were found to be related to the specific medical context (i.e., a participant’s subspecialty and the nature of a patient’s complaint).

Conclusions

The participants viewed a productive interaction as essentially goal-directed, catalyzed by the two parties clicking, and dependent on the nature of a patient’s complaint. Using the findings, we developed a conceptual process model with the four goal orientations as wheels and with clicking in the center as a flywheel. Because clicking was viewed as important, but somewhat unpredictable, teaching physicians how to click, while taking account of the medical context, may warrant greater attention.

Electronic supplementary material

The online version of this article (doi:10.1186/s12913-016-1430-6) contains supplementary material, which is available to authorized users.

Improvements in Unmarried African American Parents' Rapport, Communication, and Problem-Solving Following a Prenatal Coparenting Intervention

This report examines effects of a coparenting intervention designed for and delivered to expectant unmarried African American mothers and fathers on observed interaction dynamics known to predict relationship adjustment. Twenty families took part in the six-session "Figuring It Out for the Child" (FIOC) dyadic intervention offered in a faith-based human services agency during the third trimester of the mother's pregnancy, and completed a postpartum booster session 1 month after the baby's arrival. Parent referrals for the FIOC program were received from a county Health Department and from OBGYNs and Pregnancy Centers in the targeted community. All intervention sessions were delivered by a trained male-female paraprofessional team whose fidelity to the FIOC manualized curriculum was independently evaluated by a team of trained analysts. At both the point of intake ("PRE") and again at an exit evaluation completed 3 months postpartum ("POST"), the mothers and fathers were videotaped as they completed two standardized "revealed differences" conflict discussions. Blinded videotapes of these sessions were evaluated using the System for Coding Interactions in Dyads. Analyses documented statistically significant improvements on 8 of 12 variables examined, with effect sizes ranging from moderate to large. Overall, 14 families demonstrated beneficial outcomes, 3 did not improve, and 3 showed some signs of decline from the point of intake. For most interaction processes, PRE to POST improvements were unrelated to degree of adherence the paraprofessional interventionists showed to the curriculum. However, better interventionist competence was related to decreases in partners' Coerciveness and Negativity and Conflict, and to smaller increases in partner Withdrawal. Implications of the work for development and delivery of community-based coparenting interventions for unmarried parents are discussed.

Clinical radiotherapy audits in Belgium, 2011-2014

Systematic clinical radiotherapy audits have been introduced in Belgium in 2011, as part of the Federal Cancer Plan. This is in compliance with article 11 of the 97/43 Council directive of Euratom states, translated into the Belgian legislation by royal decree in 2002. The principle of clinical audits has thus been part of the federal legal requirements for more than 10 years. However, its application had to wait for the development of a practical approach: what authority will audit, who will be the auditors, along which methodology, at what frequency, etc. Since 2002, the Federal College of Radiotherapy has the mission to monitor quality of radiotherapy at large. It was therefore decided after discussions with the relevant administration at the Ministry of Health and the Federal Agency for Nuclear Control that the College would practically organise the audits. Early in the 2000s, the IAEA developed a manual for comprehensive audits, as a tool for quality improvement. Auditors were professionals of the domain and the audit visit took the form of a peer review. Great care was taken to assemble an audit party able to cover all aspects of clinical radiotherapy with a radiation oncologist, a medical physicist, a radiation therapist and, on demand, a quality officer. The IAEA manual contains a series of questionnaires to be prepared by the audited centre in advance (pre-audit and self-assessment), indicating what specific areas the auditors would assess. It is also a template for the auditors, ensuring that no area is left aside or forgotten during the site visit. The report, at the end of the visit, is drafted according to a specific report template, also developed by IAEA. Several members of the Belgian radiotherapy community have developed their auditor's skills by participating to the IAEA audit program; they are the core of the auditor Belgian team.

Effect of postural changes on aldosterone to plasma renin ratio in patients with suspected secondary hypertension

AIMS

To study the influence of postural changes on aldosterone to renin ratio (ARR) in patients with suspected secondary hypertension and to evaluate the sensitivity and specificity of the recommended seated ARR compared to supine and upright ARR for primary aldosteronism screening.

METHODS

Fifty-three hypertensive patients were prospectively hospitalized for secondary hypertension exploration (age: 51 ± 12, 66% males). After withdrawal of drugs interfering with renin angiotensin system, plasma aldosterone and direct renin concentration were measured in the morning, at bed after an overnight supine position, then out of bed after 1 hour of upright position and finally 2 hours later after 15 minutes of seating. Minimal renin value was set at 5 μUI/mL.

RESULTS

Referring to ARR cut-off of 23 pg/μUI, the sensitivity of seated ARR was 57.1% and specificity was 92.3%. The negative and positive predictive values were 95.1% and 45.2% respectively. Compared to these results, a cut-off of 19 improved sensitivity to 85.7% with a specificity of 89.7%. Negative and positive predictive values were 98.3% and 41.1% respectively. Seated ARR mean value was lower than supine and upright ARR mean values, due to an overall increase in renin at seating compared to the supine position by factor 1.9 while aldosterone just slightly increased by factor 1.2. Seated ARR correlated to supine and upright ARR: correlation coefficients (r) 0.90 and 0.93 respectively (P<0.001).

CONCLUSIONS

Current recommended measurement of ARR in the seating position is fairly correlated to supine and upright ARR. A suggested cut-off value of 19 instead of 23 pg/μUI increased the discriminating power of this test.

How does a physician's accurate understanding of a cancer patient's unmet needs contribute to patient perception of physician empathy?

OBJECTIVE

Unmet supportive care needs of patients decrease patient perception of physician empathy (PE). We explored whether the accurate physician understanding of a given patient's unmet needs (AU), could buffer the adverse effect of these unmet needs on PE.

METHODS

In a cross-sectional design, 28 physicians and 201 metastatic cancer patients independently assessed the unmet supportive care needs of patients. AU was calculated as the sum of items for which physicians correctly rated the level of patient needs. PE and covariates were assessed using self-reported questionnaires. Multilevel analyses were carried out.

RESULTS

AU did not directly affect PE but acted as a moderator. When patients were highly expressive and when physicians perceived poor rapport with the patient, a high AU moderated the adverse effect of patient unmet needs on PE.

CONCLUSION

Physician AU has the power to protect the doctor-patient relationship in spite of high patient unmet needs, but only in certain conditions.

PRACTICE IMPLICATIONS

Physicians should be encouraged toward AU but warned that high rapport and patient low emotional expression may impede an accurate reading of patients. In this latter case, they should request a formal assessment of their patients' needs.

Quantitative conversations: the importance of developing rapport in standardised interviewing

When developing household surveys, much emphasis is understandably placed on developing survey instruments that can elicit accurate and comparable responses. In order to ensure that carefully crafted questions are not undermined by ‘interviewer effects’, standardised interviewing tends to be utilised in preference to conversational techniques. However, by drawing on a behaviour coding analysis of survey paradata arising from the 2012 UK Poverty and Social Exclusion Survey we show that in practice standardised survey interviewing often involves extensive unscripted conversation between the interviewer and the respondent. Whilst these interactions can enhance response accuracy, cooperation and ethicality, unscripted conversations can also be problematic in terms of survey reliability and the ethical conduct of survey interviews, as well as raising more basic epistemological questions concerning the degree of standardisation typically assumed within survey research. We conclude that better training in conversational techniques is necessary, even when applying standardised interviewing methodologies. We also draw out some theoretical implications regarding the usefulness of the qualitative–quantitative dichotomy.

Likable co-witnesses increase eyewitness accuracy and decrease suggestibility

This study examines the impact of likability on memory accuracy and memory conformity between two previously unacquainted individuals. After viewing a crime, eyewitnesses often talk to one another and may find each other likable or dislikable. One hundred twenty-seven undergraduate students arrived at the laboratory with an unknown confederate and were assigned to a likability condition (i.e., control, likable or dislikable). Together, the pair viewed pictures and was then tested on their memory for those pictures in such a way that the participant knew the confederate's response. Thus, the participant's response could be influenced both by his or her own memory and by the answers of the confederate. Participants in the likable condition were more accurate and less influenced by the confederate, compared with the other conditions. Results are discussed in relation to research that shows people are more influenced by friends than strangers and in relation to establishing positive rapport in forensic interviewing.

How can we explain physician accuracy in assessing patient distress? A multilevel analysis in patients with advanced cancer

OBJECTIVE

To examine the determinants of the accuracy with which physicians assess metastatic cancer patient distress, also referred to as their empathic accuracy (EA). Hypothesized determinants were physician empathic attitude, self-efficacy in empathic skills, physician-perceived rapport with the patient, patient distress and patient expressive suppression.

METHODS

Twenty-eight physicians assessed their patients' distress level on the distress thermometer, while patients (N=201) independently rated their distress level on the same tool. EA was the difference between both scores in absolute value. Hypothesized determinants were assessed using self-reported questionnaires. Multilevel analyses were carried out.

RESULTS

Little of the variance in EA was explained by physician variables. EA was higher with higher levels of patient distress. Physician-perceived quality of rapport was positively associated with EA. However, for highly distressed patients, good rapport was associated with lower EA. Patient expressive suppression was also related to lower EA.

CONCLUSION

This study adds to the understanding of EA in oncological settings, particularly in challenging the common assumption that EA depends largely on physician characteristics or that better rapport would always favor higher EA.

PRACTICE IMPLICATIONS

Physicians should ask patients for feedback regarding their emotions. In parallel, patients should be prompted to express their concerns.