No abstract

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.

Empirical research on the teaching of interview skills has consistently shown significant (at p≤.05 level) changes on cognitive tests, affective measures, and observational data for students of various programs in the health professions. Most studies were simply comparisons of stu dents' pretest and posttest scores, with little control over possible confounding factors. Relatively few studies have in cluded direct comparisons of alternative approaches to the teaching of interview skills. These studies are examined in de tail, and trends among them are noted for the design of instructional programs. Also noted are the implications of these studies for future research.

Faculty at the University of Pennsylvania have developed a prototype course in clinical decision making that can be adapted to the diverse backgrounds of a variety of medical audiences. The course was offered in its entirety to third and fourth-year medical students and in abbreviated form to two postgraduate audiences (community and university-based physicians) during 1982. Methods were developed for content, process, and outcome evaluation for the courses; the latter consisted of pretest and posttest comparisons of performance on a written examination. Ninety-four individuals attended one or more sessions of the three courses. All courses were very favorably received, although the postgraduate audiences perceived less clinical relevance than educational relevance in the material (p less than 0.05). The medical students performed better on the pretest than either group of physicians, with the student-university physician difference reaching statistical significance (p less than 0.01). Nevertheless, all groups performed better on the posttest than on the pretest (p less than 0.001) and the degree of improvement was no different among the groups (p greater than 0.29). We conclude that our course's concepts and skills can be effectively adapted to and assimilated by physicians at all levels of training and experience.

An experimental study indicates that trained TAs make more use of objectives and engage in more student-centered teaching than do the non-trained.