A teachers' guide to teaching medical interviewing

Training Medical Students in Behavioural and Cognitive Strategies

It is argued that psychologists have an important role in ensuring appropriate training of medical students in behavioural and cognitive strategies. This paper outlines the innovative medical curriculum at the University of Newcastle and describes the contribution of cognitive psychology to the problem-solving method which underlies the curriculum. It also describes the medical school's approach to training students in interactional skills. One focus of the interactional skills training is to provide practical skills which incorporate behavioural and cognitive strategies to address common, preventable health problems, such as excessive alcohol consumption.

Medical education in substance use disorders

This paper outlines recent developments in drug and alcohol medical education, and highlights improved prospects for prevention and appropriate management of substance use disorders. The paper also presents a model of effective drug and alcohol medical education designed to induce both clinical competence and effective practice behaviour. Of particular note is the trend towards greater emphasis on skills development, especially clinical interaction skills. This emphasis is underpinned by an increasingly behavioural orientation, whereby concern is focused on fostering clinical competence in specific skills, e.g. identification, history taking and interventions. Practical examples of the application of such approaches are noted. In addition, relevance of concepts, such as self-efficacy and role legitimacy, to the area of drug and alcohol medical education is highlighted. Together with recent data on early intervention, and the widespread recognition and support for medical practitioners' involvement in drug and alcohol problems, future prospects are viewed as very encouraging.

A preliminary exploration of the interactional skills of trainee surgeons

BACKGROUND

The interactional skills of 21 surgical trainees were studied in the areas of breaking bad news to patients and preparing patients for potentially threatening medical procedures. When compared to the established guidelines for dealing with these issues, the trainees performed poorly.

METHODS

Trainees were videotaped using clinical histories delivered by simulated patients in simulated consulting rooms. All videos were scored on standard rating scales where the criteria for rating the specific interactional skills were adopted from existing guidelines.

RESULTS

The proportion of trainees who could meet the guidelines when breaking bad news was low. The proportion of trainees who met the guidelines were: closing the the consultation (0%), provided patient information about prognosis (43%) and treatment (38%) and when they gave support (10%). There were also low numbers of trainees who could meet the guidelines when they prepared patients for potentially threatening procedures. Ten per cent of trainees followed the guidelines when providing information, 25% could establish treatment goals, 35% could give a prognosis and 0% could deal appropriately with psychosocial issues or close the consultation appropriately.

CONCLUSIONS

It is concluded that there is a need for further formal training in interactional skills as part of surgical training.

Interviewing skills in relation to psychiatric residency

A review of the literature suggests that the teaching of interviewing skills in psychiatry residency programs has been largely ignored. The consequences of poor interviewing, the characteristics of good interviewing, and what is known about effective training techniques for the mastery of clinical interviewing are reviewed. The relevance of psychiatric training is discussed. Issues which warrant further research are presented.