title: The Causal Relationship between Interns' Knowledge and Self-Efficacy and Their Value in Predicting the Interns' Communication Behavior with Patients.
abstract: BACKGROUND
  After many years of teaching, both the efficiency and efficacy of communication skills programs are under question because patients' dissatisfaction with doctors' communication behavior is at the top of the complaint lists. It is assumed that finding the specific role of different determinants of doctors' communication behavior, instructional designers can plan more effective training programs. This study aims to explore the predictive value of interns' knowledge and self-efficacy in building effective relationship with patients and determine the causal relationship between interns' knowledge and self-efficacy about effective doctor-patient relationship.
  
  
  METHODS
  In this cross-sectional study, PRECEDE model was applied and the analyzed content from semi-structured interviews with 7 interns and 14 faculty members was combined with the items from literature review. All the emerged items were categorized under eight constructs of social cognitive theory. The validity and reliability of the items of the research questionnaire were examined by 40 interns and an expert panel of 14 faculty members. The questionnaires were completed by 203 medical interns and confirmatory factor analysis (CFA) was done on the items. The data were analyzed by SPSS.21 and LISREL 8.80.
  
  
  RESULTS
  CFA indicated a good fit to the data. Knowledge and self-efficacy, together, explained 23 percent of the variance in interns' communicative behavior. 53 percent of the changes in interns' self-efficacy were attributed to the changes in interns' knowledge.
  
  
  CONCLUSIONS
  Improving the interns' shared vision can increase the quality of their knowledge and instructional designs based on learning facts, and gaining insights about effective doctor-patient relationship can increase the interns' self-efficacy and consequently improve the interns' communication skills.
authors.affiliation: Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran, Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Saeideh
authors.initials: S
authors.lastname: Ghaffarifar
authors.affiliation: Department of Health Education and Health Promotion, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Fazlollah
authors.initials: F
authors.lastname: Ghofranipour
authors.affiliation: Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran.
authors.forename: Fazlollah
authors.initials: F
authors.lastname: Ahmadi
authors.affiliation: Department of Liver and Gastrointestinal Diseases, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran.
authors.forename: Manouchehr
authors.initials: M
authors.lastname: Khoshbaten
authors.affiliation: Department of College Preparatory English, Vancouver Community College, Vancouver, BC, Canada.
authors.forename: Chris
authors.initials: C
authors.lastname: Sallis
keywords: Communication skills; Doctor-patient Relationship; Interns; Knowledge; Self-efficacy