A new model for physician-patient communication.

The E4 model for physician-patient communication is presented with specific techniques for implementing the model. Derived from an extensive review of the literature on physician-patient communication, the model has proved to be a useful tool in workshops for and coaching of physicians regardless of specialty, experience or practice setting. Information on how to obtain descriptive materials about the workshop and an annotated bibliography is included.

Communication techniques for HMO physicians.

A program utilizing a council of health professionals found three areas of significant importance in physician/patient communication: inquiry, instruction and empathy. Attention to these three areas can improve patient adherence and decrease patient anxiety. The result can be more satisfied patients.

Verbal communication skills and patient satisfaction. A study of doctor-patient interviews.

This research attempted to quantify specific behaviors in the physician's initial interviewing style and relate them to patients' perception of satisfaction. Five physicians were tape recorded during their initial interviews with 52 adult patients. The patients were asked to complete the Medical Interview Satisfaction Scale, a 29-item instrument with a 7-point response scale. These interviews were transcribed, timed, coded, and analyzed with the use of the Computerized Language Analysis System. Selected variables of the language dimensions were entered as the predictor variables in a multiple regression, along with satisfaction scores as the dependent variables. Twenty-seven percent of the variance (p less than .01) in the satisfaction scores of initial interviews were explained by three aspects of a physician's language style: (a) use of silence or reaction time latency between speakers in an interview, (b) whether there was language reciprocity as determined through the reciprocal use of word-lists, and (c) the reflective use of interruptions within an interview. Considering the complexity of human communication, the fact that three variables were identified, which accounted for 27% of the variance in patients' satisfaction, is considered a substantial finding.

A micro-computer based approach to curriculum evaluation.

The wide range of content appropriate to graduate study in health administration calls for an effective means to analyze the structure and content of the graduate program curriculum. This article presents a curriculum analysis matrix approach to curriculum evaluation. The matrix approach uses spreadsheet software to carry the analysis through several iterations, involving faculty throughout the process. A case illustration is presented. This approach is deemed relevant to accreditation self-studies and to any other periodic curriculum reviews.

Teaching cost-effective diagnostic test use to medical students.

The purpose of this project was to develop and evaluate a program to teach medical students how to order diagnostic tests in a cost-effective manner. The 1-month educational program included a seminar, a simulated patient-care exercise, special case presentations by students, newsletters about diagnostic tests, and concurrent review of patients' bills. Content analysis of answers to open-ended questions and pretests and posttests were used to measure differences in the study and control groups. Although students said the program was useful, no significant differences were found in students' knowledge, attitudes, or simulated test-ordering behavior. The authors conclude that the lack of improvement in objective measures limits the potential effectiveness of restricted efforts such as this one and that the discrepancy between the subjective and objective measures reinforces the need for more rigorous evaluations of programs that teach cost-effective diagnostic test use.

A course in clinical decision making adaptable to diverse audiences.

Faculty at the University of Pennsylvania have developed a prototype course in clinical decision making that can be adapted to the diverse backgrounds of a variety of medical audiences. The course was offered in its entirety to third and fourth-year medical students and in abbreviated form to two postgraduate audiences (community and university-based physicians) during 1982. Methods were developed for content, process, and outcome evaluation for the courses; the latter consisted of pretest and posttest comparisons of performance on a written examination. Ninety-four individuals attended one or more sessions of the three courses. All courses were very favorably received, although the postgraduate audiences perceived less clinical relevance than educational relevance in the material (p less than 0.05). The medical students performed better on the pretest than either group of physicians, with the student-university physician difference reaching statistical significance (p less than 0.01). Nevertheless, all groups performed better on the posttest than on the pretest (p less than 0.001) and the degree of improvement was no different among the groups (p greater than 0.29). We conclude that our course's concepts and skills can be effectively adapted to and assimilated by physicians at all levels of training and experience.

Using patient simulators to teach clinical interviewing skills.

Patient simulators were used in an interdisciplinary nutrition course to teach interviewing skills and demonstrate the interaction of medical, psychosocial, and economic factors in a team approach to nutritional care. Simulated interviews were videotaped and followed immediately by constructive feedback. Subsequent class discussion focused on the identification of patients' needs and the respective roles and contributions of members of an interdisciplinary team. Analysis of student evaluations indicated that they perceived the experience as an effective teaching/learning technique. Patient simulation can be sued to teach and evaluate students' interviewing and counseling skills. Further experimentation and research on its application to dietetic education are needed.

Hypothesis-testing from a limited set: an example of mentally retarded subjects outperforming college subjects.

By making a discrimination problem's solution equivalent to an hypothesis (response alternation) known to be more dominant in retarded subjects than college students, superior performance by retarded subjects can be accurately predicted.

The effects of spatial, temporal, and control variables on the free-recall serial position curve of retardates and equal-MA normals.

In Experiment I seven pictures were sequentially illuminated at a 3-see rate through seven translucent windows. A different window provided the starting point for each of seven tests. Retarded and normal Ss of equal MA produced equivalent free recall and reliable recency effects. Although groups did not differ significantly at any portion of the curve, only the normals produced a significant primacy effect. The spatial end anchors produced no significant primacy or recency effects. In Experiment II total presentation time remained the same but the pictures were presented at a 1-sec rate. Variations in elapsed time and number of Presentations produced a negative primacy effect, a result attributed to the prevention of selective rehearsal and the resultant interaction of trace decay and order of recall. Superior recall by the normals, particularly in the recency portion of the curve, was attributed to group differences in order of recall strategies.