Abstract
OBJECTIVE: To evaluate an intensive training program’s effects on residents’ confidence in their ability in, anticipation of positive outcomes from, and personal commitment to psychosocial behaviors.
DESIGN: Controlled randomized study.
SETTING: A university- and community-based primary care residency training program.
PARTICIPANTS: 26 first-year residents in internal medicine and family practice.
INTERVENTION: The residents were randomly assigned to a control group or to one-month intensive training centered on psychosocial skills needed in primary care.
MEASUREMENTS: Questionnaires measuring knowledge of psychosocial medicine, and self-confidence in, anticipation of positive outcomes from, and personal commitment to five skill areas: psychological sensitivity, emotional sensitivity, management of somatization, and directive and nondirective facilitation of patient communication.
RESULTS: The trained residents expressed higher self-confidence in all five areas of psychosocial skill (p<0.03 for all tests), anticipated more positive outcomes for emotional sensitivity (p=0.05), managing somatization (p=0.03), and nondirectively facilitating patient communication (p=0.02), and were more strongly committed to being emotionally sensitive (p=0.055) and managing somatization (p=0.056), compared with the untrained residents. The trained residents also evidenced more knowledge of psychosocial medicine than did the untrained residents (p<0.001).
CONCLUSIONS: Intensive psychosocial training improves residents’ self-confidence in their ability regarding key psychosocial behaviors and increases their knowledge of psychosocial medicine. Training also increases anticipation of positive outcomes from and personal commitment to some, but not all, psychosocial skills.
Similar content being viewed by others
References
American Board of Internal Medicine. Evaluation of humanistic qualities in the internist. Ann Intern Med. 1983;99:720–4.
Commission of Education. Education for Family Practice. Reprint No. B-1600. Kansas City, MO: American Academy of Family Physicians, 1975.
Task Force on Pediatric Education. The Future of Pediatric Education. Evanston, IL: American Academy of Pediatrics, 1978.
Accreditation Council for Graduate Medical Education. Special requirements for residency training programs in internal medicine. Chicago, IL: ACGME, 1993.
Jencks SF. Recognition of mental distress and diagnosis of mental disorder in primary care. JAMA. 1985;253:1903–7.
Merkel WT, Margolis RB, Smith RC. Teaching humanistic and psychosocial aspects of care: current practices and attitudes. J Gen Intern Med. 1990;5:34–41.
Smith RC, Hoppe RB. The patient’s story: integrating the patient-and physician-centered approaches to interviewing. Ann Intern Med. 1991;115:470–7.
Roter DL, Hall JA, Katz NR. Relations between physicians’ behaviors and analogue patients’ satisfaction, recall, and impressions. Med Care. 1987;25:437–51.
Hall JA, Roter DL, Katz NR. Meta-analysis of correlates of provider behavior in medical encounters. Med Care. 1988;26:657–75.
Roter D. Which facets of communication have strong effects on outcome—a meta-analysis. In: Stewart M, Roter D (eds). Communicating with Medical Patients. London: Sage, 1989:183–96.
Freemon B, Negrete VF, Davis M, Korsch BM. Gaps in doctor-patient communication. Pediatr Res. 1971;5:298–311.
Korsch BM, Gozzi EK, Francis V. Gaps in doctor—patient communication—I. Doctor-patient interaction and patient satisfaction. Pediatrics. 1968;42:855–71.
Francis V, Korsch BM, Morris MF. Gaps in doctor-patient communication: patients’ response to medical advice. In: Stoekle JD (ed). Encounters between Patients and Doctors. Cambridge, MA: MIT Press. 1987:259–72.
DiMatteo MR, Hays R. The significance of patients’ perceptions of physician conduct: a study of patient satisfaction in a family practice center. J Community Health. 1980;6:18–34.
Putnam SM, Stiles WB, Casey-Jacob M, James SA. Patient exposition and physician explanation in initial medical interviews and outcomes of clinic visits. Med Care. 1985;23:74–83.
Carter WB, Inui TS, Kukall WA, Haigh VH. Outcome-based doctor-patient interaction analysis—II. Identifying effective provider and patient behavior. Med Care. 1982;20:550–66.
Lazare A. Hidden conceptual models in clinical psychiatry. N Engl J Med. 1973;288:345–51.
Kaplan SH, Greenfield S, Ware JE. Impact of the doctor—patient relationship on the outcomes of chronic disease. In: Stewart M, Roter D (eds). Communicating with Medical Patients. London: Sage, 1989:228–45.
Bartlett EE, Grayson M, Barker R, Levine DM, Golden A, Libber S. The effects of physician communications skills on patient satisfaction, recall, and adherence. J Chron Dis. 1984;37:755–64.
Ley P, Whitworth MA, Skillbeck CE, et al. Improving doctor-patient communication in general practice. J R Coll Gen Practitioners. 1976;26:720–4.
Haynes RB, Mattson ME, Chobanian AV, et al. Management of patient compliance in treatment of hypertension—report of the NHLBI Working Group. Hypertension. 1982;4:415–23.
Shear CL, Gipe BT, Matthies JK, Levy MR. Provider continuity and quality of medical care—a retrospective analysis of prenatal and perinatal outcome. Med Care. 1983;21:1204–10.
Egbert LD, Battit GE, Welch CE, Bartlett MK. Reduction of postoperative pain by encouragement and instruction of patients—a study of doctor-patient rapport. N Engl J Med. 1964;270:825–7.
Vacarinno JM. Malpractice—the problem in perspective. JAMA. 1977;238:861–3.
Kasteler J, Kane RL. Olsen DM, Thetford C. Issues underlying prevalence of “doctor-shopping” behavior. J Health Soc Behav. 1976;17: 328–39.
Bandura A. Self-efficacy: toward a unifying theory of behavioral change. Psychol Rev. 1977;84:191–215.
Bandura A. Self-efficacy mechanism in human agency. Am Psychol. 1982;37:122–47.
Margolies R, Wachtel AB, Schmelkin LP. Perceived self-efficacy in psychiatry. J Psychiatr Educ. 1986;10:120–8.
Tresolini CP. Stritter FT. Medical students’ development of self-efficacy in conducting patient education for health promotion: an analysis of learning experiences. Teach Learn Med. 1995: in press.
Becker MH, Janz NK. Practicing health promotion: the doctor’s dilemma. Ann Intern Med. 1990;113:419–22.
Lawrence RS. The role of physicians in promoting health. Health Aff. 1990;9:6–21.
Orlandi MA. Promoting health and preventing disease in health care settings: an analysis of barriers. Prev Med. 1987;16:119–30.
Maddux JE, Barnes JA. Cognitive processes in psychotherapy and behavior change: self-efficacy expectancy, outcome expectancy, and outcome value. Toronto: presented at annual meeting of American Psychological Association, 1984.
Bandura A. Social Foundations of Thought and Action. Englewood Cliffs, NJ: Prentice-Hall, 1986.
Bandura A. Self-referent thought: a developmental analysis of self-efficacy. In: Flavell JH, Ross L (eds). Social Cognitive Development: Frontiers and Possible Futures. Cambridge, England: Cambridge University Press, 1981:200–39.
Schunk DH. Goal setting and self-efficacy during self-regulated learning. Educ Psychol. 1990;25:71–86.
Schunk DH. Self-efficacy and classroom learning. Psychol Schools. 1985;22:208–23.
Smith RC, Marshall AA, Cohen-Cole SA. The efficacy of intensive biopsychosocial teaching programs for residents: a review of the literature and guidelines for teaching. J Gen Intern Med. 1994;9:390–6.
Williamson PR, Smith RC, Kern, DE, et al. The medical interview and psychosocial aspects of medicine: block curricula for residents. J Gen Intern Med. 1992;7:235–42.
Smith RC, Osborn G, Hoppe RB, et al. Efficacy of a one-month training block in psychosocial medicine for residents: a controlled study. J Gen Intern Med. 1991;6:535–43.
Smith RC. Teaching interviewing skills to medical students: the issue of ‘countertransference.’ J Med Educ. 1984;59:582–9.
Smith RC, Zimny G. Physicians’ emotional reactions to patients. Psychosomatics. 1988;29:392–7.
Smith RC. Use and management of physicians’ feelings during the interview. In: Lipkin M, Putnam SM, Lazare A (eds). A Textbook on Medical Interviewing. New York: Springer-Verlag, 1995.
Smith RC. Unrecognized responses by physicians during the interview. J Med Educ. 1986;61:982–4.
Gorlin R, Zucker HD. Physicians’ reactions to patients: a key to teaching humanistic medicine. N Engl J Med. 1993;308:1059–63.
Johnson AH. Assessing counselling skills and attitudes in family practice. J Fam Pract. 1979;9:447–52.
Smith RC. The patient’s story: the integrated patient—doctor model of the interview. Boston:Little, Brown, 1995; in press.
Klinger F. Consequences of commitment to and disengagement from incentives. Psychol Rev. 1975;82(1):1–25.
Knowles MS. The Modern Practice of Adult Education: From Pedagogy to Andragogy. New York: Cambridge. The Adult Education Company, 1980.
Maguire P. Teaching interviewing skills to medical students. Med Encounter. 1992;8:4–5.
McKeachie WJ, Pintrich PR, Lin Y, Smith DAF, Sharma R. Teaching and Learning in the College Classroom, 2nd ed. Ann Arbor, MI: Regents of the University of Michigan, 1990.
Smith RC. Somatization disorder: defining its role in clinical medicine. J Gen Intern Med. 1991;6:168–75.
Smith RC, Lyles JS, Mettler J, et al. Improved patient satisfaction from intensive training of residents in psychosocial medicine: a controlled randomized study. Acad Med. 1995; accepted for publication.
Author information
Authors and Affiliations
Additional information
Supported by the Fetzer Institute in Kalamazoo, MI.
Rights and permissions
About this article
Cite this article
Smith, R.C., Mettler, J.A., Stöffelmayr, B.E. et al. Improving residents’ confidence in using psychosocial skills. J Gen Intern Med 10, 315–320 (1995). https://doi.org/10.1007/BF02599950
Issue Date:
DOI: https://doi.org/10.1007/BF02599950