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The Effectiveness of Intensive Training for Residents in Interviewing: A Randomized, Controlled Study

Robert C. Smith, MD; Judith S. Lyles, PhD; Jennifer Mettler, MA; Bertram E. Stoffelmayr, PhD; Lawrence F. Van Egeren, PhD; Alicia A. Marshall, PhD; Joseph C. Gardiner, PhD; Karen M. Maduschke, MA; Jennifer M. Stanley, MA; Gerald G. Osborn, DO; Valerie Shebroe, PhD; and Ruth B. Greenbaum, MN
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From Michigan State University, East Lansing, Michigan. Acknowledgments: The authors thank the Fetzer Institute in Kalamazoo, Michigan; the biopsychosocial programs at the University of Rochester; and the American Academy on Physician and Patient. They also thank the medical school deans; department chairs in medicine, psychiatry, and family practice; program directors in medicine and family practice; general internal medicine division chiefs; and residents at Michigan State University. Grant Support: By a grant from the Fetzer Institute, Kalamazoo, Michigan. Requests for Reprints: Robert C. Smith, MD, B312 Clinical Center, Michigan State University College of Human Medicine, East Lansing, MI 48824. Current Author Addresses: Dr. Smith: B312 Clinical Center, Michigan State University College of Human Medicine, East Lansing, MI 48824.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1998;128(2):118-126. doi:10.7326/0003-4819-128-2-199801150-00008
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Background: Interviewing and the physician–patient relationship are crucial elements of medical care, but residencies provide little formal instruction in these areas.

Objective: To determine the effects of a training program in interviewing on 1) residents' attitudes toward and skills in interviewing and 2) patients' physical and psychosocial well-being and satisfaction with care.

Design: Randomized, controlled study.

Setting: Two university-based primary care residencies.

Participants: 63 primary care residents in postgraduate year 1.

Intervention: A 1-month, full-time rotation in interviewing and related psychosocial topics.

Measurements: Residents and their patients were assessed before and after the 1-month rotation. Questionnaires were used to assess residents' commitment to interviewing and psychosocial medicine, estimate of the importance of such care, and confidence in their ability to provide such care. Knowledge of interviewing and psychosocial medicine was assessed with a multiple-choice test. Audiotaped interviews with real patients and videotaped interviews with simulated patients were rated for specific interviewing behaviors. Patients' anxiety, depression, and social dysfunction; role limitations; somatic symptom status; and levels of satisfaction with medical visits were assessed by questionnaires and telephone interviews.

Results: Trained residents were superior to untrained residents in knowledge (difference in adjusted post-test mean scores, 15.7% [95% CI, 11% to 20%]); attitudes, such as confidence in psychological sensitivity (difference, 0.61 points on a 7-point scale [CI, 0.32 to 0.91 points]); somatization management (difference, 0.99 points [CI, 0.64 to 1.35 points]); interviewing of real patients (difference, 1.39 points on an 11-point scale [CI, 0.32 to 2.45 points]); and interviewing (data gathering) of simulated patients (difference, 2.67 points [CI, 1.77 to 3.56 points]). Mean differences between the study groups were consistently in the appropriate direction for patient satisfaction and patient well-being, but effect sizes were too small to be considered meaningful.

Conclusion: An intensive 1-month training rotation in interviewing improved residents' knowledge about, attitudes toward, and skills in interviewing.





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