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Progress, Problems, and Promise

Dennis H. Novack, MD; Gretchen Volk; Douglas A. Drossman, MD; Mack Lipkin, Jr, MD

JAMA. 1993;269(16):2101-2105.

Abstract
Objective.
—To assess educational practices, problems, and needs in the teaching of medical interviewing and interpersonal skills.

Design.
—Questionnaires sent to curricular deans and introductory course leaders at all US medical schools in 1991.

Results.
—Of 130 programs, 114 deans (88%) and 92 course directors (71%) responded. Respondents indicated some advances since a similar survey in 1977: Virtually all medical schools now offer teaching in medical interviewing and interpersonal skills. More faculty from a greater variety of disciplines are involved in this teaching. Most programs feature observation and feedback of students' interviews with patients, and use a variety of effective teaching methods, including simulated patients and role-playing, both little used in 1977. The majority of schools address students' personal growth through discussion or support groups. However, there are problems. Most schools lack a faculty development process. About half of the introductory courses on medical interviewing take place within physical diagnosis courses, often, it appears, without systematic observation, feedback, and evaluation of student skills. Many programs do not explicitly incorporate certain educational principles into their course designs. As in 1977, there appears to be little coordination or sequencing of teaching interpersonal skills throughout the curriculum in most medical schools. Most deans identified significant barriers to improving teaching.

Conclusions.
—While a number of educational advances have occurred there is still great variation in the quality and intensity of courses offered in US medical schools. However, the pace of progress bodes well for the future.

(JAMA. 1993;269:2101-2105)

Author Affiliations
From the Division of General Internal Medicine, Rhode Island Hospital, Brown University School of Medicine, Providence (Dr Novack), University of Rochester (NY) School of Medicine and Dentistry (Ms Volk), Division of Digestive Diseases and Nutrition, University of North Carolina at Chapel Hill School of Medicine (Dr Drossman), and Division of Primary Care, New York (NY) University Medical Center and American Academy on Physician and Patient, Baltimore, Md (Dr Lipkin).

Footnotes
Presented in part at the International Conference on Doctor-Patient Communication, Toronto, Ontario, November 16, 1991.

Reprint requests to Rhode Island Hospital, 593 Eddy St, Providence, RI 02093 (Dr Novack).

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