title: Communication skills in psychiatry residents-- how do they handle patient concerns? An application of sequence analysis to interviews with simulated patients.
abstract: BACKGROUND
  The main focus of the training of psychiatrists is on diagnosis and treatment based on the traditional doctor-centered approach to the psychiatric interview. Less attention is given to the correct handling of patients' emotional concerns, which is crucial for the patient-physician relationship, but also for improving diagnostic and treatment decisions. The aim of this study is to assess psychiatrists' responses to patients' concerns and worries.
  
  
  METHODS
  118 consultations, conducted by 10 residents in psychiatry with 20 simulated patients, have been coded using the Verona Psychiatric Interview Classification System. Lag1 sequential analysis and a multinomial logit regression analysis were performed to investigate the relationship between patients' expressions of concern and psychiatrists' subsequent interventions in terms of patient-centered skills.
  
  
  RESULTS
  Compared to doctor-centered interventions, all patients' expressions of concern increased the probability of passive listening (odds ratios between 2.4 and 4.2). They also increased the occurrence of emotion focusing interventions (odds ratios between 3.3 and 1.7), which however remained rare (4% of residents' total responses). A small although significant increase in the likelihood of active listening expressions was observed as a response to two types of patient expressions of concern: statements of feelings (odds ratio 1.4) and expression of opinions regarding problematic psychosocial issues (odds ratio of 1.7).
  
  
  CONCLUSIONS
  Young psychiatrists are good passive listeners but need to improve active listening skills which, together with emotion focusing skills, should be a major learning target in psychiatry. These patient-centered interviewing skills should integrate those traditionally used for attributing ICD-10 and/or DSM-IV categories.
authors.affiliation: Department of Medicine and Public Health, Service of Medical Psychology, University of Verona, Verona, Italy.
authors.forename: Michela
authors.initials: M
authors.lastname: Rimondini
authors.forename: Lidia
authors.initials: L
authors.lastname: Del Piccolo
authors.forename: Claudia
authors.initials: C
authors.lastname: Goss
authors.forename: Mariangela
authors.initials: M
authors.lastname: Mazzi
authors.forename: Monica
authors.initials: M
authors.lastname: Paccaloni
authors.forename: Christa
authors.initials: C
authors.lastname: Zimmermann
mesh_terms: D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D003142:Communication; D004644:Emotions / Q000502:physiology*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000592:standards*; D007406:Interview, Psychological / Q000379:methods; D007558:Italy; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D016017:Odds Ratio; D016544:Patient Simulation; D010817:Physician-Patient Relations; D011570:Psychiatry / Q000193:education*; D012017:Referral and Consultation