Question

Internal medicine - Sign of weakness

How does Terrence Holt’s description of his interactions with the “patient in room 26” illustrate different models of the patient-provider relationship or patient-provider communication?

Answer 1

Ans) The increase in communication skills training for doctors has led to the need for more effective means of evaluation. Analysis of video and audiotaped consultations using systems of interaction analysis can provide the trainee with in-depth feedback about their communication skills.

- Most interaction process systems were designed for use in primary care and recent research has questioned the applicability of these systems in medical specialties such as oncology.

- The development of a new instrument, the Medical Interaction Process System (MIPS) for use in teaching communication skills and empirical research in medical encounters, particularly, between doctors and patients with cancer.

- A comparison of the MIPS and comparable behaviour categories of another widely used system (the Roter Interaction Analysis System) was made to test convergent validity. Pearson correlation coefficients suggested a good level of concurrence between the two systems. Intercoder reliability tests were carried out between two coders at two separate time periods. Both of these indicated good reliability for the majority of categories.

- The two major advantages of the MIPS over other coding systems are:

(1) the system allows for sequential and parallel coding, thus avoiding major coding conflicts and (2) the design of the coding sheet results in a multidimensional view of the consultation without data loss. We believe that the MIPS yields useful information for teaching doctors communication skills and also provides an objective method for evaluating the effectiveness of communication skills courses.