Psychological tests to measure the effects of medical education on students'' interpersonal skills

The consulting skills required of medical students and practitioners have been categorized into a number of specific skills, two of which are: students' ability to empathize with the patient; and ability to decode non-verbal cues given by the patient in the interview. Training programmes to improve students' consulting skills are usually evaluated using analysis of students' actual interview behaviours with patients. Broad psychological and personality tests have also been used to measure changes in students' interviewing skills, but have generally not been successful. The hypothesis is advanced that more specific tests of the skills of interviewing, such as non-verbal sensitivity and empathy, would detect changes in students' ability to display these skills. As part evaluation of a consulting skills training programme, clinical students completed psychological tests of empathy and non-verbal sensitivity. Subsequent comparisons between trained and control student groups revealed no clear pattern in test results. These data suggest that specific psychological tests of empathy and non-verbal sensitivity may be no more effective in detecting changes in students' interpersonal skills than global personality measures.     

Use of a general medical setting to teach medical students about neurosis

A new way of teaching medical students about minor psychiatric illnesses is described. Psychiatric morbidity on general medical wards was identified, using medical students to administer the screening instrument to all routine admissions and interview possible cases. This was linked to a weekly teaching round in the same setting conducted by a psychiatrist. Advantages of this method of teaching were (1) it increased the overall numbers of patients clerked by our students during their psychiatric clerkship; (2) it increased the number of cases of neurosis seen by students as compared with psychotic illnesses; and (3) it related teaching on psychiatric conditions to settings where most students would eventually practise. The aim was both to increase the students' factual knowledge about minor psychiatric illnesses as encountered in these settings, and to improve their skills at identifying and treating such illnesses. An attempt was made to measure the effectiveness of this teaching method. All students showed an improvement in test scores, whether taught under the new regime or not, but it proved impossible to distinguish those taught on medical wards from those taught primarily in psychiatric wards. The implications of this finding are discussed. There was uniformly positive feedback from the students who took part in the study.     

Teaching interviewing skills to paediatric junior clerks using simulated mothers

In this article a training programme is described for improving interviewing skills of students in the fifth year (junior clerkship) of the medical curriculum. Two interviews with a 'simulated mother' form the core of the programme. The interviews are immediately followed by a feedback session in which the simulated mother discusses the strong and the weak points of the interview. In the feedback she makes use of a checklist with relevant points concerning the content and the process of the interview. Where required the comments are substantiated with fragments of the videotaped interview. In a 2-hour theoretical session, students are told how to prepare themselves for the interview. The learning effects of the training programme using simulated mothers were evaluated in order to determine: (1) the subsequent improvement in interviewing skills; and (2) the effect of the feedback session. It was found that students' interviewing skills improved significantly on the content and the process aspects after one or two interviews. In addition the feedback sessions proved very helpful, although no significant differences were revealed, when comparing the mean group scores for students who had had feedback sessions with the scores for those who had not. The results also revealed that two interviews were insufficient and that the training should include at least three interviews. This was borne out by the large number of students who asked for more interviews with simulated mothers. In the training programme the simulated mothers perform two functions: (1) playing the role of the mother of a sick child; and (2) giving feedback to students regarding their interviewing skills.(ABSTRACT TRUNCATED AT 250 WORDS)     

The patient is the expert: a technique for teaching interviewing skills

Aspects of a teaching development intended to encourage patient-centredness in medical interviewing is discussed. Patients are asked by their local general practitioner to volunteer their time in order to be interviewed by medical students and then to stay on afterwards to discuss their impressions of the students' behaviour. It is argued that this approach to teaching interviewing skills enables students to examine the assumptions they make about the patient and to become aware of their difficulties in discussing sensitive issues.     

Training clinical teachers in psychiatry to teach interviewing skills to medical students

To study the feasibility of training all clinical teachers in psychiatry to teach interviewing skills to medical students, 24 (unselected clinicians were assigned to one of four different training methods. They received either experiential or didactic instruction, and their initial teaching sessions were either supervised or unsupervised. A total of 287 medical students subsequently received feedback training from these teachers. While all students showed significant increases in skill after training, those taught by experientially trained teachers showed the greatest gains. Neither supervision nor the teachers' own interviewing skills exerted significant effects on students' performance. It is concluded that with only brief training unselected clinicians can become effective teachers of essential interviewing skills. Feedback training in such skills can, therefore, be incorporated into existing curricula without major disruption of other requirements.     

Factors influencing the communication skills of first-year clinical medical students

The aim of this study was to examine the factors influencing medical students' communication skills. The sample comprised all first-year clinical students. Thirty-two received teaching in communication skills during the year; the remaining 56 did not. Students' career preferences, attitudes towards communication skills and confidence in their ability to communicate with patients were assessed by questionnaire at the beginning and end of the year. At the end of the year each student was videotaped interviewing a simulated patient. Students' communication skills were assessed on the basis of this interview by raters using a standardized rating scale, and by patient questionnaires. While there was some evidence that brief communication skills training improved skills, sex of student was a more significant predictor of level of skill. Students who perceived communication skills as less relevant to medicine and those who were more confident about their own communication skills were more likely to prefer a career in hospital medicine. Students' judgements of their ability to communicate effectively were poor. In the main there was no relationship between confidence and level of skill: where they were related, the association was negative. The benefits from communication skills training might be enhanced by involving hospital doctors in the teaching, and providing students with detailed video feedback on their skills at the outset.     

A factor analytic study of clinical competence in undergraduate psychiatry

This study used factor analysis to define the components of clinical competence of medical students during their undergraduate psychiatric training. Four factors were defined; factor 1 related to cognitive and psychological problem-solving; factor 2 tapped the interpersonal and observational skills students showed with patients; factor 3 was characterized by knowledge in the examination setting, and factor 4 related to students' capacity to demonstrate their ability in an interpersonal setting. These are similar to the component skills of clinical competence demonstrated by students in other areas of the medical curriculum. They also correspond to the skills which Walton (1986) has suggested should be focused upon in undergraduate psychiatric education.     

Teaching medical students about neurosis

Practices used by medical schools in Great Britain and Ireland in the teaching of neurosis to medical students were assessed using postal questionnaires distributed to heads of departments, and to medical students at the end of their psychiatric attachments. In addition, medical students' factual knowledge about neurotic illnesses was measured using a brief multiple choice question (MCQ) test distributed with the questionnaire. There was considerable dissatisfaction among heads of departments with the way neurosis is taught, and there was general agreement that students see too many patients with psychotic illnesses and too few neurotics. Most neurotic patients are seen within departments of psychiatry and heads of department felt there was too little use of other settings such as general medical wards or general practice. Factual knowledge about neurosis as assessed by the MCQ was generally poor. Knowledge about neurotic illnesses relates most closely to the time devoted by departments to formal lectures on neurosis and is inversely related to the proportion of psychotic patients seen by students. Teaching of techniques of medical interviewing including the use of audio and video feedback of interviewing skills and behaviours is now widespread in British medical schools. There was no tendency for students receiving such teaching to display a better knowledge about neurosis.     

Do students develop better motivational interviewing skills through role‐play with standardised patients or with student colleagues?

OBJECTIVE: Smoking is the leading cause of preventable death in the USA and reducing the number of smokers by 50% is among the goals of the Healthy People 2010 initiative. Despite its importance, few medical students receive formal training in smoking cessation counselling. Motivational interviewing is a patient-centred, but directive, method of counselling that has been found to be more effective than giving brief advice for motivating smokers to quit. We wanted to determine whether using standardised patients to teach this skill to Year 3 medical students would be more effective than using student role-plays. METHODS: We conducted a randomised, controlled trial of 93 Year 3 family medicine clerkship students at our medical school between July 2003 and July 2004. The control group (n=46) practised motivational interviewing with one another and the intervention group (n=47) practised with standardised patients trained in motivational interviewing for smoking cessation. At the end of the study all the students conducted an interview with a different standardised patient that was videotaped. The primary outcome was analysis by a trained masked evaluator of the quality of a final videotaped interview using the motivational interviewing treatment integrity code (MITI), which assesses the quality of the interview according to 6 different criteria. RESULTS: There was no significant difference between the control and intervention groups in the final analyses of the interviews. CONCLUSIONS: According to MITI scores, standardised patient role-plays are similar in effectiveness to student role-plays when teaching basic motivational interviewing skills for smoking cessation to Year 3 medical students.     

Students'' attitudes towards psychiatry

Using a reliable measure, a self-administered questionnaire (ATP), and adequate numbers of students, this study demonstrates the negative effects of general medical/surgical training and the positive effect of the psychiatry clerkship on students' reported attitudes towards psychiatry. A negative view of psychiatry at the beginning of the clerkship may make students reluctant to improve their interview skills but is otherwise unimportant in determining their reactions and performance in the clerkship. Medical students' interest in psychiatry as a career increases during the psychiatry clerkship but this merely offsets the decline in interest that occurs at other stages during the clinical training. Much of the attitudinal change that occurs during the psychiatry clerkship is maintained into the pre-registration year but the housemen recorded a significant negative change on the items concerning efficacy of psychiatric treatment and attitudes towards psychiatric patients. Additional training by psychiatrists during the pre-registration year might increase the motivation of young doctors to detect and treat psychiatric illness which they will encounter in all branches of medicine.     

A communication skills course for preclinical students: evaluation of general practice based teaching using group methods

Summary. Teaching preclinical medical students about doctor-patient communication gives them an opportunity to develop their interviewing skills prior to their having to elicit lists of symptoms in their clinical years. General practitioners should be among the more efficient interviewers in clinical medicine and therefore able to make important contributions to the teaching of interviewing skills. This paper describes the aims, objectives and methods of the preclinical communications skills course at St George's Hospital Medical School. The contribution of the Division of General Practice and Primary Care to the teaching of interviewing skills in the preclinical course has been evaluated using rapid group methods. Students were asked to identify examples of specific interviewing behaviours in videotaped general practice consultations, and to judge whether the behaviours were helpful or unhelpful in eliciting relevant information from the patient. Students who had been given experience in interviewing patients in small groups led by general practitioners identified significantly more helpful and unhelpful interviewing behaviours in the taped consultations than students who had not received the small-group teaching. Students rated the teaching as relevant and effective in terms of giving insights into the interviewing skills they needed to develop. Group methods of evaluation such as these might prove useful to other medical schools with class sizes of 150 students or more.     

Effects of communication skills training on students'' diagnostic efficiency

This study evaluates the impact of a training programme in communications skills on subsequent diagnostic efficiency. Videotaped history-taking interviews conducted by groups of specially trained and control groups of students were rated for their diagnostic efficiency by two medical practitioners. Students in the trained group had shown greatly increased skills in interviewing and interpersonal effectiveness as a result of their training. A comparison of ratings given by the two experimentally naive, independent observers revealed that trained students were significantly better at eliciting full, relevant data from patients--they were diagnostically more efficient, but took no longer than their control group counterparts to elicit the information. Further research with the medical interview rating scale will clarify the skills required of medical students in interviewing and diagnosis and facilitate remedial training for students who show poor interview skills.     

Educational assessment of general practice experience for psychiatric trainees

Eighteen psychiatric trainees spent 6 months each as general practice trainees. The educational impact of the experience was assessed by a self-assessment questionnaire, a semi-structured interview and a videotaped interview with a psychiatric patient. Each assessment was conducted at baseline and after 12 months. A control group of 14 trainees was recruited from the same rotation. On the self-assessment questionnaire, the study registrars rated their abilities to solve general medical problems significantly improved compared to controls. They had also acquired greater understanding of the limitations of their knowledge and their legal responsibilities towards their patients. The semi-structured interview failed to distinguish between the two groups. Videotapes for rating at baseline and follow-up were available for only 17 of the trainees. Assessment of the tapes used the Maguire Scale and the Interview Behaviour Scale. Neither scale demonstrated any intervention effect. The interviews were all characterized by a preponderance of 'closed psychological' and 'checking-out' questions. It appears that psychiatric trainees' interviewing styles had not been influenced by the experience. This study suggests that psychiatric trainees gain greater confidence in their role as a doctor and greater understanding of the scope and nature of general practice by such an attachment. It is unclear whether or not supplementary interviewing skills had been acquired which were not utilized in the taped interview, which conforms very much to traditional psychiatric examination behaviour. Trainees were reassured that they had increased their knowledge without losing any of their specific professional skills.     

Patient preferences and the bedside manner

An interview training model was tested and students' performances compared with patients' preferences and ratings of the students. The model was found to have some effect in improving performance. Students who were rated high in their interviewing skills tended to be rated highly by patients.     

Consulting skills training and medical students' interviewing efficiency

In more traditional medical education, medical students took a patient's medical history by asking a series of sequenced, routine questions, covering presenting medical problem(s); medical history; social and personal history; systems review; and physical examination. Following this process, the student then attempted to derive the patient's medical problems. This inductive problem-solving paradigm may not assist students to prepare for their future interviewing needs, given doctors use a hypothetico-deductive, problem-solving approach when interviewing patients and numerous researchers have developed specialized communication skills training programmes designed to enhance students' interviewing skills. Students given specific consulting skills training have tended to show significantly greater interpersonal effectiveness and improved interview behaviours compared with students who experience traditional patient clerking training. These improvements in interviewing tend to persist over the period of students' medical training. The aim of the present study was to determine whether specialized communication skills training helped students elicit greater quantity and quality of information from patients and if so, whether such information assisted students in improving their diagnostic skills. Videotaped history-taking interviews conducted by students trained in communication skills and untrained (control) students were rated for their interview efficiency. A comparison of ratings given by experimentally naive, independent observers revealed that trained students were more efficient, but took no longer than their control group counterparts to elicit fuller, more relevant information. However, the student groups did not differ in the accuracy or scope of their medical diagnoses. It is argued that students' lack of medical knowledge in this early phase of their clinical training militated against their being able to use their interviewing competence to derive more potentially accurate medical diagnoses.     

Improving the skills of established general practitioners: the long-term benefits of group teaching

This study set out to determine the long-term benefits of teaching psychiatric interview skills. Nine established general practitioners, eight of whom were also trainers, took part some 18 months after attending a problem-based interviewing course. Interview skills were assessed by rating behaviour during 10-minute videorecorded simulated consultations with role-players, recorded before and after training and at follow-up. The finding of an earlier study that, in terms of the course model, training successfully modified the doctor's behaviour, was largely replicated. In addition, not only were acquired skills maintained but further change took place during the follow-up period, change that can be seen as improvement in terms of the course model.     

Medical students'' attitudes to psychiatry in Chile

There is controversy about the influence of psychiatric clerkships on medical students' attitudes to psychiatry. In general, studies in developed countries have found a short-lasting improvement in attitudes to psychiatry after a psychiatric clerkship. The present study was designed to measure changes in medical students' attitudes following a psychiatric clerkship in a developing country. Medical students from the Faculty of Medicine, University of Chile were interviewed before and after a psychiatric clerkship using a translation into Spanish of an attitude-to-psychiatry questionnaire used previously in the UK. The results were similar to those reported from developed countries. There was a marked early improvement in students' attitudes following their psychiatric clerkship which gradually faded over 3 years. There is scope for improvement in psychiatric undergraduate medical teaching in Chile and this might help to make more lasting improvements in attitudes to psychiatry among medical students.     

Increasing empathy among medical students

The objective of the research was to evaluate the short- and long-term effectiveness of teaching medical students interviewing skills. Methods of teaching communication skills included a workshop for clinical instructors, as an indirect approach, a workshop for medical students, as a direct approach, and a combination of both. Results demonstrated that in order to stimulate medical students to use supporting-interview skills, they themselves should participate in an interpersonal skills workshop. Being taught these skills by teachers who have participated in the workshop does not have the same positive effect.     

Interviewing skills training--a study

A randomized investigation was conducted to study the effect of a structural 10-week course on the development of interviewing skills of first year medical students. The experimental group (16 students) received interviewing skills training based on the Developmental Helping Model as described by Carkhuff in 1982. The comparison group (16 students) received traditionally focused training with emphasis on gathering information about the patient's presenting problem through the use of open-ended questions. The dependent measure was interviewing skills level. Each student was videotaped with a simulated patient during the initial (pre-test) and final (post-test) sessions of the course. Tapes were rated by blinded reviewers according to Carkhuff's five point scale of Developmental Helping. No pre-test differences were found between groups. At post-test, the experimental group showed significantly higher ratings. This data suggests that teaching specific interviewing skills is more effective than non-skill oriented training for development of medical students' ability to interview patients.     

A new approach to preparing students for academic medicine

Critical thinking and self-directed learning by students are goals strongly endorsed by medical educators. Teaching medical interviewing and physical diagnosis skills is one of the most important tasks in medical school. An elective for fourth-year students was designed to address both areas. Ten senior medical students spent one month with a teaching staff member and fellow in general medicine. Part of the course was designed for independent problem-solving posed by sophisticated medical problems encountered in a general medicine practice. Skills in problem formulation, reading and assessing the medical literature, and communicating with peers were learned or improved. In the remainder of this course five pairs of senior students precepted 28 randomly chosen second-year students and taught medical interviewing and physical diagnosis. Techniques of teaching and basic pathophysiology were reviewed, and role-playing, feedback, demonstration and role-modelling were used.