title: Verbal Aggressiveness Among Physicians and Trainees.
abstract: OBJECTIVE
  To better understand verbal aggressiveness among physicians and trainees, including specialty-specific differences.
  
  
  METHODS
  The Infante Verbal Aggressiveness Scale (IVAS) was administered as part of a survey to 48 medical students, 24 residents, and 257 attending physicians. The 72 trainees received the IVAS and demographic questions, whereas the attending physicians received additional questions regarding type of practice, career satisfaction, litigation, and personality type.
  
  
  RESULTS
  The IVAS scores showed high reliability (Cronbach α = 0.83). Among all trainees, 56% were female with mean age 28 years, whereas among attending physicians, 63% were male with mean age 50 years. Average scores of trainees were higher than attending physicians with corresponding averages of 1.88 and 1.68, respectively. Among trainees, higher IVAS scores were significantly associated with male sex, non-US birthplace, choice of surgery, and a history of bullying. Among attending physicians, higher IVAS scores were significantly associated with male sex, younger age, self-reported low-quality of patient-physician relationships, and low enjoyment talking to patients. General surgery and general internal medicine physicians were significantly associated with higher IVAS scores than other specialties. General practitioners (surgeons and medical physicians) had higher IVAS scores than the specialists in their corresponding fields. No significant correlation was found between IVAS scores and threats of legal action against attending physicians, or most personality traits. Additional findings regarding bullying in medical school, physician-patient interactions, and having a method to deal with inappropriate behavior at work were observed.
  
  
  CONCLUSIONS
  Individuals choosing general specialties display more aggressive verbal communication styles, general surgeons displaying the highest. The IVAS scoring system may identify subgroups of physicians with overly aggressive (problematic) communication skills and may provide a backdrop for educating physician communicators. The relationship between verbal aggressiveness and efficacy of clinical communication merits inquiry.
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Jenny Lynn
authors.initials: JL
authors.lastname: Lazarus
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: Motahar
authors.initials: M
authors.lastname: Hosseini
authors.affiliation: Department of Public Health Analysis, School of Community Health and Policy, Morgan State University, Baltimore, Maryland.
authors.forename: Farin
authors.initials: F
authors.lastname: Kamangar
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland.
authors.forename: David H
authors.initials: DH
authors.lastname: Levien
authors.affiliation: Department of Surgery, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
authors.forename: Pamela A
authors.initials: PA
authors.lastname: Rowland
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland. Electronic address: gkowdley@stagnes.org.
authors.forename: Gopal C
authors.initials: GC
authors.lastname: Kowdley
authors.affiliation: Department of Surgery, Saint Agnes Hospital, Baltimore, Maryland. Electronic address: Steven.Cunningham@stagnes.org.
authors.forename: Steven C
authors.initials: SC
authors.lastname: Cunningham
mesh_terms: D000374:Aggression; D004503:Education, Medical, Graduate; D005260:Female; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008505:Medical Staff, Hospital; D008875:Middle Aged; D015203:Reproducibility of Results; D014705:Verbal Behavior
keywords: Interpersonal and Communication Skills; Patient Care; Professionalism; communication; core competencies; infante score; specialty; surgeon; verbal aggression