An evaluation of residency training in interviewing skills and the psychosocial domain of medical practice.
Competent use of interviewing skills is important for the care of all patients but is especially critical, and frequently deficient, in meeting the needs of patients experiencing emotional distress. This study presents an evaluation of a curriculum in communication and psychosocial skills taught to first-year medical residents. A randomized experimental design compared trained and untrained residents' (n = 48) performances with a simulated patient presenting with atypical chest pain and psychosocial distress. Evaluation was based on analysis of videotapes, simulated patient report of residents' behaviors, and chart notation. Trained compared with untrained residents asked more open-ended questions and fewer leading questions, summarized main points more frequently, did more psychosocial counseling, and were rated as having better communication skills by the simulated patient. The use of more focused and psychosocially directed questions, and fewer leading and grab-bag questions, was associated with more accurate diagnoses and management recorded in the medical chart. However, no significant difference was found in the charting practices of trained versus untrained residents.
Department of Health Policy and Management, Johns Hopkins University, School of Hygiene and Public Health, Baltimore, MD 21205.
D L
DL
Roter
K A
KA
Cole
D E
DE
Kern
L R
LR
Barker
M
M
Grayson
D002637:Chest Pain / Q000523:psychology; D002983:Clinical Competence / Q000592:standards*; D003142:Communication; D003376:Counseling; D003479:Curriculum; D005069:Evaluation Studies as Topic; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007407:Interviews as Topic / Q000379:methods / Q000592:standards*; D008487:Medical History Taking / Q000592:standards*; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis*; D010865:Pilot Projects; D011320:Primary Health Care / Q000592:standards*; D016032:Randomized Controlled Trials as Topic; D012381:Role Playing; D012650:Self Disclosure; D014743:Videotape Recording