Purpose Humanistic care is regarded as important by patients and professional accrediting agencies, but little is known about how attitudes and behaviors in this domain are taught in clinical settings. To answer this question, the authors studied how excellent clinical teachers impart the behaviors and attitudes consistent with humanistic care to their learners. Method Using an observational, qualitative methodology, the authors studied 12 clinical faculty identified by the medical residents enrolled from 2003 to 2004 as excellent teachers of humanistic care on the inpatient medical services at four medical universities in the United States (University of Minnesota Medical School, Emory University, University of Rochester School of Medicine, and Baylor College of Medicine). Observations were conducted by the authors using standardized field notes. After each encounter, the authors debriefed patients, learners (residents and medical students), and the teaching physicians in semistructured interviews. Results Clinical teachers taught primarily by role modeling. Although they were highly aware of their significance as role models, they did not typically address the human dimensions of care overtly. Despite the common themes of role modeling identified, each clinical teacher exhibited unique teaching strategies. These clinical teachers identified self-reflection as the primary method by which they developed and refined their teaching strategies. Conclusions Role modeling is the primary method by which excellent clinical teachers try to teach medical residents humanistic aspects of medical care. Although clinical teachers develop unique teaching styles and strategies, common themes are shared and could be used for the future development of clinical faculty.

Role modeling humanistic behavior: learning bedside manner from the experts.

OBJECTIVE: To determine the prevalence, topics, methods, and intensity of ongoing faculty development (FD) in teaching skills. DESIGN: Mailed survey. PARTICIPANTS: Two hundred and seventy-seven of the 386 (72%) U.S. teaching hospitals with internal medicine residency programs. MEASUREMENTS: Prevalence and characteristics of ongoing FD. RESULTS: One hundred and eight teaching hospitals (39%) reported ongoing FD. Hospitals with a primary medical school affiliation (university hospitals) were more likely to have ongoing FD than nonuniversity hospitals. For nonuniversity hospitals, funding from the Health Resources Services Administration and >50 house staff were associated with ongoing FD. For university hospitals, >100 department of medicine faculty was associated. Ongoing programs included a mean of 10.4 topics (standard deviation, 5.4). Most offered half-day workshops (80%), but 22% offered ≥1-month programs. Evaluations were predominantly limited to postcourse evaluations forms. Only 14% of the hospitals with ongoing FD (5% of all hospitals) had “advanced” programs, defined as offering ≥10 topics, lasting >2 days, and using ≥3 experiential teaching methods. These were significantly more likely to be university hospitals and to offer salary support and/or protected time to their FD instructors. Generalists and hospital-based faculty were more likely to receive training than subspecialist and community-based faulty. Factors facilitating participation in FD activities were supervisor attitudes, FD expertise, and institutional culture. CONCLUSIONS: A minority of U.S. teaching hospitals offer ongoing faculty development in teaching skills. Continued progress will likely require increased institutional commitment, improved evaluations, and adequate resources, particularly FD instructors and funding.

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Teaching the teachers: national survey of faculty development in departments of medicine of U.S. teaching hospitals.

Fourteen general practice trainees took part in a course specifically designed to improve their psychiatric interviewing skills. The trainees were instructed in the problem-based model and were taught in a group setting with the use of videotape feedback. A significant improvement was demonstrated in the trainees' ability to identify psychiatric illness accurately, and there were significant changes in their interview behaviours after training. Those who were below average before training showed the greatest improvement. The implications of these findings are discussed. Group video feedback training is as effective as one-to-one video feedback training in improving the psychiatric interviewing skills of GP trainees, and could be more widely employed in general practice vocational training.

Improving the psychiatric skills of the general practice trainee: An evaluation of a group training course

THIS REPORT DESCRIBES A ONE-MONTH ROTATION for firstyear internal medic ine residents in interviewing skills and the psychosocial content of medical practice. It summarizes the evidence that training is needed in these domains, and reviews the ways in which po l icy makers and training programs have here tofore responded. It discusses the successes, pitfalls, and stage of deve lopmen t and evaluation of such training efforts. During recent decades, contr ibut ions f rom psychiatry and f rom the social, behavioral , and communicat ion sciences have expanded the diagnostic, educational, and therapeut ic potent ia l of the medical i n t e rv iew) Yet the quali ty of current p h y s i c i a n pat ient interactions is often poor. Studies have shown that pat ients ' visits are usual ly physician-centered2-5; pat ients ' concerns are f requent ly ignored 3, 6, 7; ill-defined compla in ts are accep ted wi thou t clarification 4, s; and patients ' educat ional needs of ten are not met. s, 6, 9 Dissatisfaction wi th the p h y s i c i a n p a t i e n t relationship is f requent ly ci ted as a reason for malpract ice claims.X0, H Although psychosocial p rob lems are c o m m o n in medical pat ients 1222 and patients wi th these p rob lems use medical services heavily, 21, 23 medical educat ion has tended to separate the b iomedica l f rom the psychosocial componen t s of care. 24, 25 As a result, psychosocial p rob lems f requent ly are unrecognized, misdiagnosed, or poor ly managed. 13, ~4, ~s, 26-33 When t rea tment is offered, physicians are m u c h more l ikely to prescr ibe psychot ropic drugs than to provide counsel ing or therapeut ic listening. 27 Studies not only have d o c u m e n t e d deficiencies in p h y s i c i a n p a t i e n t interactions, but also have l inked the quality of p h y s i c i a n p a t i e n t interactions to the quali ty of care. Good interviewing skills are impor tant in achieving an accurate diagnosis, 2, 4, 34-44 effective pat ient educat ion, 4°, 45 pat ient satisfaction, 7, 29, 4o, 44.50 pat ient compl iance , 4°, 4s, 51.53 and favorable health outcomes. 5457 Detect ion and management of pat ient ' s psychosocial p rob lems also can have beneficial resuits. ~7, 58-63 Professional organizations and governmenta l

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Residency training in interviewing skills and the psychosocial domain of medical practice.

Mental health training of primary care residents: a review of recent literature (1974-1981).

The increasing recognition of the importance of a well-developed set of interpersonal skills to the competent family physician has resulted in a rapid growth in the formal teaching of interpersonal skills within family practice residencies. Of the 168 programs responding to a national survey of family practice residencies, 88 percent indicated that they have formal programs in interpersonal skills. It is estimated that there are well over 500 family practice faculty members who have special responsibilities in teaching interpersonal skills. While most programs address the component skills of the interpersonal process (eg, demonstrating empathy, information gathering, information giving, and psychological intervention), it is of concern that only about half offer explicit training in patient education (53 percent), specific types of counseling (eg, family counseling, 55 percent), or some of the specific interpersonal skills important in team practice and practice management (eg, supervisory skills). One of the most striking findings was that 88 percent of the reporting programs use videotechnology, with 77 percent of these planning to increase their use. Although most programs evaluate their interpersonal skills training using both indirect and direct assessment methods, only 25 percent attempt to use patient outcome as a measure of teaching effectiveness.

B Cohen

Papers

Teaching interpersonal skills in family practice: results of a national survey.